Dialysis Facility Staffing Ratios and Kidney Transplantation

Studies have shown that higher patient-to-nurse ratios at dialysis facilities are associated with worse patient outcomes in older adults. Researchers at the University of California, San Francisco, led by Alexandra Bicki, conducted a retrospective analysis of data from the US Renal Data System of patients 12 to 30 years of age who initiated dialysis from 2005 to 2019 at dialysis facilities in the United States.

The primary exposure was patient-to-nurse ratio at the dialysis facility. The relationship of the primary exposure to receipt of kidney transplant (living or deceased donor) was examined using Cox models.

Results of the analysis were reported during a poster session at the American Society of Nephrology Kidney Week 2023. The poster was titled Higher Dialysis Facility Patient-to-Nurse Staffing Ratio Is Associated With Lower Hazard of Kidney Transplantation Among Adolescents and Young Adults.

The analysis included data on 51,419 individuals. Of those, 74% were ≥22 years of age, and 84% initiated therapy with hemodialysis. Median staffing ratio was 14 patients per one nurse. During a median follow-up of 2.4 years, 53% of patients <22 years of age versus 34% of those ≥22 years of age received a kidney transplant.

In adjusted analysis, each doubling of patient-to-nurse ratio at a facility resulted in a 15% lower hazard of transplantation (hazard ratio [HR], 0.85; 95% CI, 0.84-087). There was an interaction (P<.001) by age at dialysis initiation: the association between higher patient-to-nurse ratio and access to transplantation was more pronounced in patients 12 to 21 years of age (HR, 0.79; 95% CI, 0.77-0.82) compared with patients 22 to 30 years of age (HR, 0.96; 95% CI, 0.94-0.99)

“Adolescents and young adults receiving care from facilities with higher patient-to-nurse ratios had lower hazard of transplantation compared [with] those receiving care [from] facilities with lower staffing ratios,” the authors said. “Low dialysis nurse staffing ratios may represent a crucial facility characteristic that promotes successful kidney transplantation, particularly for adolescents.”

Source: Bicki A, Mcculloch CE, Grimes BA, Ku E. Higher dialysis facility patient-to-nurse is associated with lower hazard of kidney transplantation among adolescents and young adults. TH-PO897. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2023; November 3, 2023; Philadelphia, Pennsylvania