CHAPTER 5: Epidemiology—Adult Kidney Transplantation

SECTION 1: INTRODUCTION

Chronic and End Stage Kidney Disease

• Five stages of chronic kidney disease (CKD)¹:

  • Stage 1: estimated glomerular filtration rate (GFR) ≥90 mL/min per 1.73 m² ≥3 months proteinuria

  • Stage 2: estimated GFR 60–89 mL/min per 1.73 m² ≥3 months proteinuria

  • Stage 3: estimated GFR 30–59 mL/min per 1.73 m²

  • Stage 4: estimated GFR 15–29 mL/min per 1.73 m²

  • Stage 5: estimated GFR <15 mL/min per 1.73 m²

• 15% of U.S. adults have CKD, but only 10% are aware of it²

• Prevalence of CKD by age groups²:

  • ≥65 years of age: 38%

  • 45–64 years of age: 12%

  • 18–44 years of age: 6%

• Prevalence of CKD:²

  • Women: 14%

  • Men: 12%

  • Non-Hispanic blacks: 16%

  • Hispanics: 14%

  • Non-Hispanic whites: 13%

  • Non-Hispanic Asians: 13%

• Overall Medicare costs for CKD >$81.8 billion, $23,700/patient³

• Total Medicare spending (not inclusive of prescription drugs) for ESRD or kidney failure: $36.6 billion, $80,000/patient (2018)³

• Prevalence of ESRD with respect to Caucasians¹:

  • 3.7 times increase among African Americans

  • 1.4 times increase among Native Americans

  • 1.5 times increase among Asian Americans

Transplantation vs. Dialysis

• Improved long-term survival

• Enhanced quality of life

Symptoms of kidney failure:

• Anemia

• Fatigue

• Weakness

• Nausea

• Metal taste

• Skin color changes

• Loss of muscle mass

• Muscle cramps

Who should receive a kidney transplant?

• All medically suitable patients with chronic and end-stage renal disease

Mortality while on dialysis:

• >50% at 5 years

SECTION 2: ORGAN PROCUREMENT AND TRANSPLANTATION NETWORK (OPTN) AND SCIENTIFIC REGISTRY OF TRANSPLANT RECIPIENTS (SRTR) DATA^4–6

Data from:

• https://www.srtr.org/reports/srtroptn-annual-data-report/⁴

• Hart A, Smith JM, Skeans MA, et al. OPTN/SRTR 2018Annual data report: Kidney. Am J Transplant. 2020;20(Suppl s1):20–130. doi:10.1111/ajt.15672⁵

• Hart A, Lentine KL, Smith JM, Miller JM, Skeans MA, Prentice M, Robinson A, Foutz J, Booker SE, Israni AK, Hirose R, Snyder JJ. OPTN/SRTR 2019 Annual Data Report: Kidney. Am J Transplant. 2021 Feb;21 Suppl 2:21–137. doi: 10.1111/ajt. 16502. PMID: 33595191⁶

Waiting List^4–6

• Number of wait list candidates remains stable

• Associated increase in both live and deceased donor transplants

Wait list candidates:

• ∼40% age 50–64 years

• ∼60% male

• ∼40% diabetic (most frequent cause of kidney failure)

• ∼17% on dialysis for ≥6

• Increasing proportion of Hispanic and Asian candidates

• Decreasing proportion of whites

• Increasing proportion (∼20%) of preemptive listings

• ∼60% willingness among candidates ≥65 years of age to accept organs with Kidney Donor Profile Index (KDPI) >85% (2019)

• ∼40% willingness among candidates of all ages to accept organs with KDPI >85% (2019)

• ∼30% willingness among candidates of all ages to accept organs from a donor with hepatitis C (2019)

• Increased transplant ...