A Social Network Analysis of Hemodialysis Clinics: Attitudes Toward Living Donor Kidney Transplant among Influential Patients

Key PointsHemodialysis clinic social networks spread attitudes and behaviors toward kidney transplants.Identifying and characterizing influential patients is a first step in future hemodialysis clinic social network interventions to promote kidney transplantation.BackgroundHemodialysis clinics help develop patient social networks that may spread kidney transplant (KT) attitudes and behaviors. Identifying influential social network members is an important first step to increase KT rates. We mapped the social networks of two hemodialysis facilities to identify which patients were influential using in-degree centrality as a proxy for popularity and influence.MethodsIn this cross-sectional study, we performed a sociocentric social network analysis of patients on hemodialysis in two geographically and demographically different hemodialysis facilities. Statistical and social network analyses were performed using R statistical software.ResultsMore patients at facility 1 (N=71) were waitlisted/evaluating living donor KT (50.7% versus 20.0%, P = 0.021), considered KT as very important (70.4% versus 45.0%, P = 0.019), and knew people who received a successful KT (1.0 versus 0.0, P = 0.003). Variables predicting relationship formation at facility 1 were the same shift (β=1.87, 95% confidence interval [CI] [1.19 to 2.55]; P < 0.0001), same sex (β=0.51, 95% CI [0.01 to 1.00]; P = 0.045), younger age (β=-0.03, 95% CI [-0.05 to -0.01]; P = 0.004), different lengths of time on hemodialysis (β=-0.49, 95% CI [-0.86 to -0.12]; P = 0.009), and knowing more people who received a successful KT (β=0.12, 95% CI [0.03 to 0.21]; P = 0.009). Predictive variables at facility 2 (N=40) were the same race (β=2.52, 95% CI [0.39 to 4.65]; P = 0.021) and knowing fewer people with successful KT (β=-0.92, 95% CI [-1.82 to -0.02]; P = 0.045). In-degree centrality was higher at facility 1 (1.1±1.2) compared with facility 2 (0.6±0.9).ConclusionsSocial networks differed between the hemodialysis clinics in structure and prevalent transplant attitudes. Influential patients at facility 1 (measured by in-degree centrality) had positive attitudes toward KT, whereas influential patients at facility 2 had negative attitudes.