Proper Staffing Key to Kidney Transplant Access for Young Patients
For young people with kidney disease, every day on dialysis can feel like their life is paused while the rest of the world keeps going.
Dialysis partially replaces the kidney’s functions until a transplant is available, but it is exhausting and time-consuming. New research led by the Department of Pediatrics at UC San Francisco shows that when dialysis facilities had more patients per staff member, adolescents and young adults had reduced access to transplants, meaning more time on dialysis and the associated health risks.
The results, published recently in the Journal of the American Medical Association, highlight the essential role that nurses and social workers play in a dialysis care team that successfully guides young patients and their families through the transplant process.
Impact of a Delayed Kidney Transplant
“Dialysis takes a toll on patients, requiring either nightly home treatments or multiple weekly clinic visits. These demanding treatments can lead to fatigue, poor appetite, and disruptions to daily life,” said Alexandra Bicki, MD, MPH, first author of the study and an assistant professor of pediatrics in the Division of Nephrology at UCSF.
“Prolonged dialysis can significantly hinder the progress of adolescents and young adults, delaying their education and career goals, and reducing their overall quality of life,” said Bicki. Young people accordingly have high priority on the national kidney transplant waitlist and are likely to receive donor organ offers quickly, but only once they are successfully on the list.
Looking at dialysis centers across the United States, Bicki’s research found that young patients at centers with fewer nurses and social workers available to each patient were put on the waitlist less often and had a 14% reduced chance of receiving a transplant, compared to patients at facilities with more staff support per patient. The disparities were more pronounced in those who started dialysis when they were younger than 22 years old.
Nurses and Social Workers as Transplant Guides
Becoming eligible for a kidney transplant is a complex process requiring scans, blood tests, mental health assessments, and other evaluations. A successful transplant relies on nurses and social workers at dialysis units helping doctors coordinate care, educating patients and their families about the process, and offering individualized support at every step.
“Living with chronic kidney disease for many years in childhood can cause issues with executive functioning, time management, and organization—which are all necessary skills to become a successful kidney transplant candidate,” said Bicki. “When staffing levels are adequate, and the care team is not spread too thin, nurses and social workers have an incredible amount of ‘face time’ with patients to learn about their lives at home and help them instill positive habits.”
Progressing Toward Equitable Care
The study notes that although two states have recently implemented staffing requirements for pediatric patients, the same staffing standards apply nationally to adult and pediatric centers. However, a new payment program piloted by the Centers for Medicare & Medicaid Services aims to help all children receive the care and support they need at dialysis centers through more accurate payments for the complex and costly services.
“At UCSF, I have seen the incredible relationships our dialysis nurses and social workers form with our young patients,” said Bicki. “They are in tune with each patient's medical complexity and what support they have, enabling them to efficiently usher patients through the requirements to get them a transplant and off dialysis.”
The study’s senior author is Elaine Ku, MD, MAS, associate professor of medicine and pediatrics, of the UCSF Department of Pediatrics. Learn more about our Pediatric Kidney Transplant Program and Pediatrics Dialysis Unit, one of only two Northern California units specializing in dialysis treatment for infants, children, and adolescents.