Publication Spotlight: Dr. Amaral

Read the interview with Sandra Amaral, MD, MHS Associate Professor of Pediatrics at the Children's Hospital of Philadelphia and author of Association Between Dialysis Facility Ownership and Access to the Waiting List and Transplant on Pediatric Patients With End-stage Kidney Disease in the US.

What question did your study aim to answer?

We sought to examine whether the profit status (being profit or non-profit) of a dialysis facility was associated with access to the waiting list or transplant for children with end-stage kidney disease.

What inspired you to conduct this study?

Differences in transplant access by profit status have been noted in adults on end-stage kidney disease, but not in children. Children on dialysis are very different from adults and require specialized pediatric expertise. This is often hard to access when children are remote from pediatric academic centers where most pediatric nephrologists practice. Also, many adult dialysis units will not accept smaller, younger children in their units. So, we were interested in learning more about the association of pediatric kidney transplant access and dialysis centers across the United States.

Which USRDS datasets did you use to conduct your study?

We used the Patients file, MEDEVID file, the Facility file, RXHIST file WAITLIST_KI file and TX file.

Using plain language, please summarize your study conclusions in two or three points.

Among children who were receiving dialysis in the United States between 2000 and 2018, children who were cared for at for-profit dialysis centers were 21% less likely to be waitlisted and 29% less likely to be transplanted compared with children who received care at non-profit dialysis facilities. Our study identifies disparities in access to transplant for children at for-profit dialysis centers. Further study is needed to understand the driving forces of these observations.

Please share a specific insight about working with USRDS data that you learned during the completion of this study.

The USRDS is an invaluable resource to researchers. This robust database enabled us to identify patients and follow them from dialysis to waitlisting and transplant. No other database in the United States is this comprehensive for examining pediatric end-stage kidney disease.