New Approach To Kidney Transplant Listing Could Improve Outcomes And Equity

The existent kidney transplant waitlisting criterion is based connected a azygous measurement of kidney usability (estimated glomerular filtration complaint [eGFR] ≤20 ml/min/1.73m2) and does not see an individual's consequence of progressing to kidney failure. A caller study reveals that inclusion of a patient's 2-year consequence of progression to kidney nonaccomplishment (using nan Kidney Failure Risk Equation [KFRE], which incorporates age, sex, urine albumin, and eGFR) arsenic a decision-making instrumentality toward pre-emptive listing for kidney transplantation, has nan imaginable to amended diligent outcomes and trim group disparities. The findings will beryllium presented astatine ASN Kidney Week 2025 November 5–9.

When examining nan usage of nan 2-year consequence of progression to kidney nonaccomplishment of ≥25% based connected nan KFRE arsenic listing criterion and comparing it pinch nan existent eGFR ≤20 criterion, investigators recovered that among 10,368 US veterans pinch chronic kidney illness successful 2022 who would meet astatine slightest 1 of nan criteria, 60% met some and 20% met only 1 aliases nan other. 

In 2022, veterans who only qualified by nan eGFR ≤20 criterion were older (71 years) than those who only suffice by KFRE ≥25% (53 years). Also, utilizing nan kidney illness progression criteria only, much males, minorities (Hispanic, Black, and Asian), and those pinch glucosuria and/or albuminuria would beryllium waitlisted. When examining longitudinal information (2006–2019) to measure outcomes, nan group who met some criteria aliases nan KFRE ≥25% only, had nan highest rates of kidney nonaccomplishment and little mortality compared pinch those who only met nan eGFR ≤20 criterion.

Expanding nan waitlisting criteria for kidney transplantation to see consequence of kidney nonaccomplishment prioritizes individualized approaches to attraction and could amended outcomes successful younger patients pinch chronic kidney disease, arsenic good arsenic amended group parity successful entree to kidney transplantation. This attack will proceed to beryllium studied prospectively and successful populations beyond veterans to verify its imaginable to amended diligent outcomes."

Jennifer L. Bragg-Gresham, MS, PhD, corresponding author of nan University of Michigan Medical School