Barriers to kidney transplant referral in the state of Minas Gerais: nephrologists' perspectives.

BACKGROUND: In Brazil, there is a low percentage of patients on the waiting list for kidney transplantation (KT), even within a public health system with full coverage. Among the factors influencing referral, those related to the nephrologist are the least studied. We aimed to investigate the barriers to KT referral from the perspective of nephrologists in the state of Minas Gerais. METHODS: Cross-sectional study of a convenience sample of active nephrologists. We collected data through an electronic survey, including demographic profile, education, professional profile, knowledge about indications (6) and contraindications (12), and clinical practice. Non-parametric analyses were performed. RESULTS: The 77 nephrologists had a median age of 44.9 years (IQR 39-52) and a median of 12.5 years (IQR 3-23) of clinical practice; all had completed postgraduate training. The median number of expected responses regarding contraindications was 8 (IQR 6-9) out of 12, and 66.2% had more than 50% of correct responses. There were no significant associations with this pattern of responses (< 8). The nephrologists reported knowing the referral process and identified the presence of contraindications as the main cause for non-referral. Centers were public (54.5%) and non-academic (55.8%); 69.2% were located within < 100 km of a KT center, most offered KT as a treatment modality (80.4%), only 14.7% reported difficulties with pre-KT laboratory tests, and 21-40% of patients were reported to be listed (31.2%). CONCLUSION: We found knowledge gaps in KT contraindications and risk perception as causes for non-referral. Barriers related to centers and the health system were not reported. These findings support educational initiatives and greater integration between nephrology services and KT centers to enable referrals.