BACKGROUND Nephrology is one of the pediatric subspecialties with the largest workforce shortage in the US. Waitlist registration is one of the first steps towards kidney transplantation and is facilitated by pediatric nephrologists. The objective of this study was to determine whether state-level density of pediatric nephrologists is associated with access to waitlisting (primary outcome) or kidney transplantation (secondary outcome) in children with kidney failure. METHODS Using Cox proportional hazards and logistic regression analyses, we studied children <18 years who developed kidney failure between 2016-2020 according to the US Renal Data System, the national kidney failure registry. The density of pediatric nephrologists (determined by the count of pediatric nephrologists per 100,000 children in each state) was estimated using workforce data from the American Board of Pediatrics and categorized into three groups: > 1, 0.5-1, and <0.5. RESULTS We included 4,497 children, of whom 3,198 (71%) were waitlisted and 2,691 (60%) received transplantation. Children residing in states with pediatric nephrologist density >1 had 33% (HR 1.33; 95%CI 1.07-1.66) and 22% (HR 1.22; 95%CI 1.02-1.45) better access to waitlisting compared to those residing in states with <0.5 pediatric nephrologist density (reference group) in unadjusted and adjusted analysis, respectively. Pediatric nephrologist density was particularly important for the odds of preemptive waitlisting (adjusted OR 1.56; 95% CI 1.02-2.41). The adjusted HR was 1.25 (95% CI 1.00-1.55, p=0.046) for deceased donor transplantation and 1.24 (95% CI 0.85-1.82) for living donor transplantation for children residing in states with pediatric nephrologist density > 1 compared to the reference group. CONCLUSIONS Children residing in states with higher pediatric nephrologist density had better access to waitlist registration, especially preemptively, and deceased donor transplantation.

中文翻译：

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美国儿科肾病学劳动力和肾衰竭儿童移植的可及性。


背景 肾脏病学是美国劳动力短缺最严重的儿科亚专科之一。候补名单登记是肾移植的第一步，由儿科肾病学家提供便利。本研究的目的是确定州级儿科肾病学家的密度是否与肾功能衰竭儿童获得等待名单（主要结果）或肾移植（次要结果）有关。方法 使用 Cox 比例风险和 logistic 回归分析，我们研究了根据美国肾数据系统（国家肾功能登记处）在 2016-2020 年间发生肾功能衰竭的 <18 岁儿童。使用美国儿科医师委员会的劳动力数据估计儿科肾病学家的密度（由每个州每 100,000 名儿童的儿科肾病学家人数确定），并分为三组：> 1、0.5-1 和 <0.5。结果我们纳入了 4,497 名儿童，其中 3,198 名 （71%） 被列入候补名单，2,691 名 （60%） 接受了移植。在未调整和调整分析中，与居住在儿科肾脏病学密度为 <0.5 的州（参考组）的儿童相比，居住在儿科肾病学密度为 >1 的州的儿童获得候补名单的机会分别提高了 33%（HR 1.33;95%CI 1.07-1.66）和 22%（HR 1.22;95%CI 1.02-1.45）。儿科肾病学家密度对于抢占式候补名单的几率尤为重要 （校正 OR 1.56;95% CI 1.02-2.41）。与参考组相比，居住在儿科肾脏病学密度 > 1 的州的儿童，已故供体移植的调整 HR 为 1.25 （95% CI 1.00-1.55，p=0.046），活体供体移植为 1.24 （95% CI 0.85-1.82）。 结论 居住在儿科肾病学密度较高的州的儿童更容易获得候补名单登记，尤其是抢先登记和已故供体移植。