Distance to Kidney Transplant Center and Access to Early Steps in the Kidney Transplantation Process in the Southeastern United States

Clin J Am Soc Nephrol. 2020 Apr 7;15(4):539-549. doi: 10.2215/CJN.08530719. Epub 2020 Mar 24.


Background and objectives: Access to kidney transplantation requires a referral to a transplant center for medical evaluation. Prior research suggests that the distance that a person must travel to reach a center might be a barrier to referral. We examined whether a shorter distance from patients' residence to a transplant center increased the likelihood of referral and initiating the transplant evaluation once referred.

Design, setting, participants, & measurements: Adults who began treatment for ESKD at any Georgia, North Carolina, or South Carolina dialysis facility from 1/1/2012 to 12/31/2015 were identified from the US Renal Data System. Referral (within 1 year of dialysis initiation) and evaluation initiation (within 6 months of referral) data were collected from all nine transplant centers located in that region. Distance was categorized as <15, 15-30, 31-60, 61-90, and >90 miles from the center of a patient's residential zip code to the nearest center. We used multilevel, multivariable-adjusted logistic regression to quantify the association between distance with referral and evaluation initiation.

Results: Among 27,250 adult patients on incident dialysis, 9582 (35%) were referred. Among those referred, 58% initiated evaluation. Although patients who lived farther from a center were less likely to be referred, distance was not statistically significantly related to transplant referral: adjusted odds ratios of 1.08 (95% confidence interval, 0.96 to 1.22), 1.07 (95% confidence interval, 0.95 to 1.22), 0.96 (95% confidence interval, 0.84 to 1.10), and 0.87 (95% confidence interval, 0.74 to 1.03) for 15-30, 31-60, 61-90, and >90 miles, respectively, compared with <15 miles (P trend =0.05). There was no statistically significant association of distance and evaluation initiation among referred patients: adjusted odds ratios of 1.14 (95% confidence interval, 0.97 to 1.33), 1.12 (95% confidence interval, 0.94 to 1.35), 1.04 (95% confidence interval, 0.87 to 1.25), and 0.89 (95% confidence interval, 0.72 to 1.11) for 15-30, 31-60, 61-90, and >90 miles, respectively, compared with <15 miles (P trend =0.70).

Conclusions: Distance from residence to transplant center among patients undergoing long-term dialysis in the southeastern United States was not associated with increased likelihood of referral and initiating transplant center evaluation.

Keywords: ESRD; Georgia; North Carolina; South Carolina; United States; adult; chronic kidney failure; data systems; distance; humans; kidney; kidney transplantation; logistic models; referral; referral and consultation; renal dialysis; transplant evaluation; transplantation; transplants.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Catchment Area, Health*
  • Female
  • Health Services Accessibility*
  • Healthcare Disparities
  • Humans
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / surgery*
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care*
  • Referral and Consultation*
  • Southeastern United States / epidemiology
  • Time Factors
  • Travel*
  • Young Adult