Thursday, December 18, 2025 12/18/2025

Reaching Equity in ACess to Home Dialysis And Re-Transplantation (REACH-DART)

Award Number: R01DK132271
ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 05/15/2022
PERIOD OF PERFORMANCE END DATE: 02/28/2026

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Reaching Equity in ACess to Home Dialysis And Re-Transplantation (REACH-DART) - PROJECT ABSTRACT Kidney transplantation and home dialysis are the preferred treatment modalities for end-stage kidney disease (ESKD) given the better quality of life and lower cost of these modalities compared with in-center hemodialysis. However, in patients with graft failure, rates of preemptive re-listing for a second kidney transplant and use of peritoneal dialysis (PD) are suboptimal, especially in Black and Hispanic kidney transplant recipients (KTRs). While barriers in access to transplantation or PD in transplant-naïve patients have been attributed to lack of patient awareness of their kidney disease, late referral for subspecialty care, and inadequate education, these factors should not apply to a population that already received a kidney transplant, were likely exposed to dialysis before their first transplant, and who have access to nephrology care. Disappointingly, only half of KTRs treated with PD before their kidney transplant choose to return to this modality following graft failure, and only 15% of patients with graft failure are relisted preemptively for a second kidney transplant. The rate of PD use and relisting is particularly low in Black and Hispanic KTRs with graft failure. Identifying barriers that can be addressed to improve access of former KTRs to home dialysis and repeat transplantation will not only improve the outcomes of patients with graft failure, but also inform our understanding of the roadblocks that are present even when access to care is unlikely to be the explanatory factor. In Aim 1, we propose to model the time spent in the advanced stages of graft dysfunction and determine whether there are racial or ethnic disparities in this time, which is critical for the preparation of patients for the next phase of their disease. We will then determine if the time spent in the advanced stages of graft dysfunction is associated with access to PD or re-registration on the waitlist for a second kidney transplant. In Aim 2, we will perform semi-structured interviews with patients, dialysis providers, and transplant providers to understand their perceptions of the barriers to PD and preemptive relisting. We will then use the data derived from these qualitative interviews to develop a survey that will be administered nationally to confirm the importance of these barriers and identify strategies that can be used to surmount these barriers. In Aim 3, we will examine system-level factors that may contribute to disparities in preemptive relisting on the national waitlist and PD access, including variations in the use of objective assessments of frailty during candidacy evaluations and the frequency of follow-up contact between KTRs and their transplant center peri-graft failure. To accomplish our aims, we will leverage data from the United States Renal Data System that will be linked to Medicare, Medicaid, and Optum claims data. In a subset of patients, we will collect more granular local data from electronic health record systems to enrich these administrative data. The data from this proposal will inform the interventions, best practices, and policies that are needed to promote access to repeat transplantation and PD.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $0 )
2026	2025	REGENTS OF THE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, THE	1855 FOLSOM ST STE 425	SAN FRANCISCO	CA	94103	SAN FRANCISCO	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	4	12/1/2025	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2025 ( Subtotal = $679,060 )
2025	2025	REGENTS OF THE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, THE	1855 FOLSOM ST STE 425	SAN FRANCISCO	CA	94103	SAN FRANCISCO	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	4	7/28/2025	NON-COMPETING CONTINUATION	$679,060
														Subtotal = $679,060

Issue Date FY: 2024 ( Subtotal = $655,538 )
2024	2024	REGENTS OF THE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, THE	1855 FOLSOM ST STE 425	SAN FRANCISCO	CA	94143	SAN FRANCISCO	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	3	2/2/2024	NON-COMPETING CONTINUATION	$614,568
2024	2024	REGENTS OF THE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, THE	1855 FOLSOM ST STE 425	SAN FRANCISCO	CA	94103	SAN FRANCISCO	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	001	3	5/7/2024	NON-COMPETING CONTINUATION	$40,970
														Subtotal = $655,538

Issue Date FY: 2023 ( Subtotal = $700,665 )
2023	2023	REGENTS OF THE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, THE	1855 FOLSOM ST STE 425	SAN FRANCISCO	CA	94143	SAN FRANCISCO	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	2	2/23/2023	NON-COMPETING CONTINUATION	$700,665
														Subtotal = $700,665

Issue Date FY: 2022 ( Subtotal = $750,413 )
2022	2022	REGENTS OF THE UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, THE	1855 FOLSOM ST STE 425	SAN FRANCISCO	CA	94143	SAN FRANCISCO	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	1	5/12/2022	NEW	$750,413
														Subtotal = $750,413

Grand Total All Awards = $2,785,676

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Reaching Equity in ACess to Home Dialysis And Re-Transplantation (REACH-DART)

Award Number: R01DK132271

ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 05/15/2022

PERIOD OF PERFORMANCE END DATE: 02/28/2026

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