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Efforts Needed To Address Disparities In Kidney Transplantation

November 22, 2010

1. Low Income Individuals Are Donating Fewer Kidneys Kidney Donations by the Poor Are on the Decline

Research shows that people with low incomes are more likely to develop kidney failure and less likely to receive a living donor kidney transplant than people of other socioeconomic classes. Because fewer individuals in the U.S. are donating kidneys, Jagbir Gill, MD (St. Paul’s Hospital, University of British Columbia, in Vancouver, Canada) and colleagues examined trends in kidney donation based on income. Data from the Organ Procurement and Transplantation Network/United Network for Organ Sharing (2000-2007) and the US 2000 Census revealed that rates of living donation are inversely related to median household income. Rates of living kidney donation declined in all income groups over time, but the largest decline was seen in the lowest income group, where living donations decreased by 5 per million population between 2004 and 2007. (The rates decreased by 1 donor per million population in the two highest income groups, making the absolute decrease in living donor rates 5-fold greater in the lowest income group compared with the highest income groups.) “This is important as it helps us identify potential barriers to living kidney donation and minimize these barriers so that everyone who wishes to donate a kidney to a loved one has the opportunity to do so,” said Dr. Gill.

Study co-authors include James Dong, Caren Rose, and John Gill, MD (St. Paul’s Hospital, University of British Columbia, in Vancouver, Canada).

Disclosures: The authors reported no financial disclosures.

The study abstract, “The Retraction of Living Kidney Donation Is Most Marked among the Poor,” [SA-FC451] will be presented as an oral presentation on Saturday, November 20 at 4:30 PM MT in Room 712 of the Colorado Convention Center in Denver, CO.

2. Certain Steps Get Black Kidney Disease Patients on Early Transplant Waiting Lists Improved Communication and Care Can Overcome Barriers

It’s a good idea for kidney disease patients to get on a transplant waiting list before beginning dialysis, because it may improve their chances of getting a kidney when needed. Previous research has shown that black patients are significantly less likely than whites to be preemptively waitlisted in this way; however, no studies have examined this issue among patients who have discussed kidney transplantation with their doctors before starting dialysis. Nancy Kutner, PhD (Emory University) and her colleagues examined whether these racial disparities exist even among patients who had discussed kidney transplant with doctors before beginning dialysis. Between 2005 and 2007, the investigators surveyed 1,634 dialysis patients; 813 (49.8%) reported that kidney transplantation had been discussed with them before starting dialysis. Only 60 (7%) of these patients were preemptively wait-listed; blacks made up a similar percentage of patients who were preemptively (29.3%) and not preemptively (26.6%) wait-listed. Preemptively wait-listed patients were more likely to be employed and have private insurance and less likely to have diabetes and heart-related conditions. These patients also had higher average hemoglobin, serum albumin, and serum creatinine, and were more likely to have received care from a kidney specialist before starting dialysis. Two-thirds of preemptively wait-listed patients reported that kidney transplantation was discussed with them 12 months or more before starting dialysis. Importantly, this study found no significant racial difference in preemptive wait-listing among patients who had discussed kidney transplantation with their doctor before starting dialysis. “Patients’ early discussion of kidney transplantation as a treatment option, linked with early nephrology care, appeared to diminish barriers to black patients’ placement on a kidney transplant waiting list before dialysis start,” said Dr. Kutner.

Study co-authors include Rebecca Zhang, Yijian Huang, PhD (Emory University); and Kirsten Johansen, MD (Emory University and San Francisco VA Medical Center, University of California, San Francisco).

Disclosures: Dr. Johansen receives grants/research support from Amgen and Abbott Laboratories and is a scientific advisor for the Amgen Nephrology Advisory Board. All other authors reported no other financial disclosures.

The study abstract, “Race, Predialysis Transplant Discussion, and Preemptive Wait Listing in a National Cohort,” [SA-FC452] will be presented on Saturday, November 20 at 4:42 PM MT in Room 712 of the Colorado Convention Center in Denver, CO.

3. Black Race and Neighborhood Poverty Affect Kidney Transplant Success in Children Better Access to Care May Address Inequalities

Racial and socioeconomic disparities exist in every aspect of kidney transplantation, from placement on a waiting list to living without organ rejection. Because little is known about the effects of race and socioeconomic status on organ rejection in children, Rachel Patzer, Sandra Amaral, MD (Emory University) and colleagues studied 4,320 patients under 21 who received a kidney transplant between 2000 and 2006; 18.4% experienced organ rejection within an average 3.6 years. Blacks demonstrated nearly twice the risk of organ rejection at any given time versus white non-Hispanics. In contrast, Hispanic whites had a 23% reduced risk of organ rejection versus non-Hispanic whites. After taking into account demographic, clinical, and socioeconomic factors, racial disparity remained high, with blacks at a 50% increased risk for organ rejection versus white non-Hispanics. Poverty also increased patients’ chances of organ rejection: those from the poorest neighborhoods had a 20% greater risk of organ rejection than patients in the wealthiest neighborhoods. “Our findings suggest that among children with ESRD, black patients and those living in poor neighborhoods experience a shorter time to graft failure; this may be a reflection of differential access to care. Targeting advocacy and education programs to poorer neighborhoods may be a new way to improve post-transplantation outcomes in pediatric ESRD,” said Dr. Amaral.

Study co-authors include Nancy Kutner, PhD and William McClellan, MD (Emory University).

Disclosures: Dr. McClellan receives grant/research support from and is a scientific advisor for Amgen. All other authors reported no other financial disclosures.

The study abstract, “Racial Disparities and Neighborhood Poverty in Pediatric Renal Allograft Survival,” [SA-FC453] will be presented on Saturday, November 20 at 4:54 PM MT in Room 712 of the Colorado Convention Center in Denver, CO.

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