Abstract
Aim: Preemptive kidney transplantation (PKT) is an ideal renal replacement therapy for end-stage renal disease (ESRD); however, the rate of PKT is still low in Japan. This is because there is a disparity between the attitudes toward PKT, including the timing of referral to a transplant facility, between clinicians treating patients with chronic kidney disease (CKD) and transplant centers. Therefore, we conducted a survey of clinicians and transplant centers, inquiring about the timing of PKT induction. Materials and Methods: Forty-two attendees (all clinicians) of a seminar about renal disease who had treated CKD and the 31 leading Japanese kidney transplant facilities in 2009 were surveyed about PKT induction. The inquiries consisted of questions concerning the acknowledgment of the necessity for PKT, timing until referral, etc. Results: The response rate was 59% for attendees and 76% of them had referred patients to transplant facilities for PKT. Thirty-seven percent did so when the glomerular filtration rate (eGFR) fell to less than 30mL/min/1.73mm2. However, the same percent did not do so until it became less than 15mL/min/1.73mm2. More than half of the attendees referred patients for PKT when the serum creatinine was elevated to above 5mg/dL, and less than half of them did so when it rose to above 3mg/dL. On the other hand, more than half of the patients were referred to transplant facilities when their eGFR fell to under 15mL/min/1.73mm2; thus, only 20% could actually undergo PKT in most facilities. Surprisingly, 62% of the facilities experienced referral after dialysis access creation. Most facilities required earlier referral, in CKD stage3 or 4, which was a clear difference between CKD clinicians and transplant facilities. Conclusion: Even CKD clinicians who understand and favor PKT tend to delay referral to transplant facilities. Thus, suitable timing for referral is the key to increasing PKT.
