# Identifying Facilitators and Barriers to Home Dialysis and Living Donor Kidney Transplantation among Adolescents and Young Adults

> **NIH NIH F32** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2023 · $90,528

## Abstract

PROJECT SUMMARY/ABSTRACT
 Although survival of children receiving kidney replacement therapy (KRT, including kidney transplantation,
hemodialysis, and peritoneal dialysis) has steadily improved over time, kidney failure continues to confer
significant mortality risk. This increased risk continues into young adulthood: those aged 18-44 years have the
highest rates of emergency department use, hospitalization, and 30-day readmissions of all patients with
kidney failure, even though these younger patients have fewer comorbidities than older patients receiving
dialysis. Kidney transplantation is the preferred KRT modality for patients of all ages, followed by home dialysis
options (home hemodialysis or peritoneal dialysis). Yet, over 60% of adolescents and young adults initiate
dialysis with in-center hemodialysis, which is associated with worse survival as compared to home-based
options. Disappointingly, less than 20% of those aged 13-17 years and even fewer young adults receive
preemptive transplantation, which is suboptimal given the presence of parents who could serve as potential
living donors. The complex care coordination underlying the transplant waitlist activation and living donor
identification processes are often spearheaded by social workers within dialysis facilities. Inadequate access to
social workers may be a barrier to attainment of living donor transplantation, especially in a younger and more
vulnerable population who may have lower levels of self-efficacy and require more support than older adults to
navigate a complex healthcare system.
 We seek to identify facilitators and barriers to adolescents’ and young adults’ pursuit of optimal KRT
modalities. This training plan will equip Dr. Bicki with the statistical, mixed-methods, and hands-on skills
needed to design future interventions to increase uptake of preferred modalities. UCSF provides an excellent
training environment to conduct this proposal, given it is one of the largest transplant centers in the United
States, and has unique tools available to enable qualitative analysis. Our specific aims are:
Aim 1: To examine the association between patient-to-social worker ratio at dialysis facilities and access to
transplantation among adolescents and young adults (aged 14-21 years) with kidney failure treated with
dialysis using the US Renal Data System, the national end-stage kidney disease registry.
Aim 2: To use a mixed-methods approach to identify facilitators and barriers to home dialysis and
transplantation among adolescents and young adults (aged 14-21 years).

## Key facts

- **NIH application ID:** 10752438
- **Project number:** 1F32DK137551-01
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Alexandra Bicki
- **Activity code:** F32 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $90,528
- **Award type:** 1
- **Project period:** 2024-04-01 → 2026-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10752438

## Citation

> US National Institutes of Health, RePORTER application 10752438, Identifying Facilitators and Barriers to Home Dialysis and Living Donor Kidney Transplantation among Adolescents and Young Adults (1F32DK137551-01). Retrieved via AI Analytics 2026-06-04 from https://api.ai-analytics.org/grant/nih/10752438. Licensed CC0.

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