Barreiras para encaminhamento para transplante renal em Minas Gerais: visão dos nefrologistas

Abstract

Background: The low percentage of patients with chronic kidney disease placed on the kidney transplant waiting list remains a major challenge in Brazil, even within a public healthcare system that ensures comprehensive coverage. Referral and pretransplant laboratory evaluation are prerequisites for listing, yet these steps have been poorly studied. Beyond clinical conditions, other barriers to referral exist, including patient, provider, and health system factors. Among these, gaps remain regarding nephrologist-related barriers. Objective: This study aimed to investigate barriers to referral for kidney transplant evaluation from the perspective of nephrologists in the state of Minas Gerais, Brazil. Methods: This was a cross-sectional study using a convenience sample of practicing nephrologists in the state, conducted between December 2023 and June 2024. Participants completed an electronic questionnaire addressing demographic characteristics, professional training, knowledge of transplant indications (6 items) and contraindications (12 items), and institutional profile. Nonparametric comparisons were conducted to assess knowledge performance on contraindications, categorized by the median number of correct responses (> vs. <8). Results: Seventy-seven responses were obtained (16% response rate). Nephrologists had a median age of 44.9 years (IQR 39–52) and a median of 12.5 years (IQR 3–23) in practice; all had completed postgraduate training. Knowledge of transplant indications was high, with over 90% of respondents correctly identifying 5 of the 6 indications. The median number of correct responses regarding contraindications was 8 out of 12 (IQR 6–9), with 66.2% answering more than 50% correctly. No significant associations were found with performance below the median (<8). Nephrologists reported being familiar with the referral process and cited the presence of contraindications as the main reason for non-referral. Most centers were public and academic (33.8%), with 69.2% located within 100 km of a transplant center and 84.4% offering transplant services. Only 14.7% reported difficulties in obtaining pretransplant tests, and 31.2% reported having 21–40% of their patients listed. Conclusion: The findings reveal gaps in knowledge regarding transplant contraindications and a perceived risk that may contribute to under-referral. No significant barriers were identified at the institutional or systemic levels. These results support the need for targeted educational initiatives and enhanced integration between nephrology services and transplant centers to facilitate appropriate referrals.