Disparities in Completion Rates of the Medical Prerenal Transplant Evaluation by Race or Ethnicity and Gender

Abstract

Background A significant number of potential kidney transplant candidates do not complete the required medical evaluation after referral to a transplant program. Methods Factors associated with rate of completion of the renal transplant evaluation were analyzed using a retrospective chart review of patients first seen between October 1, 2009 and September 30, 2010 (n=256). The primary end point was completion in 12 months. Independent variables included socioeconomic, demographic, and medical factors. Results Mean age was 50.7 years; 49.6% were black, 28.5% Hispanic, and 21.9% white/other; 26.3% did not require dialysis. During follow-up, 23.4% did not complete the evaluation. Multivariable analysis indicated that slower rates of completion were associated with needing a greater number of medical tests (compared to 0–2: 3–5 tests, hazard ratio (HR)=0.65, p=0.02; ≥6 tests, HR=0.47, p=0.0005) and requiring >1 hospitalization (compared to none: HR=0.37, p=0.0008). A significant interaction between race/ethnicity and gender on completion was found: compared to black men, Hispanic men (HR=2.75, p<0.0001), Hispanic women (HR=1.96, p=0.006), and white men (HR=1.99, p=0.005) had more rapid completion. In comparison, black and white women (HR=1.38, p=0.16; HR=0.94, p=0.83, respectively) were not significantly different from black men in rates of completion. Differences by race/ethnicity and gender were not confounded by socioeconomic variables or social support. Conclusions In order to lessen barriers and facilitate renal transplantation, black men and women, white women, and patients needing multiple medical tests and requiring several hospitalizations may benefit from additional assistance during the medical evaluation process.

Has the Department of Veterans Affairs Found a Way to Avoid Racial Disparities in the Evaluation Process for Kidney Transplantation?

“…This may not be the only factor, however. Monson et al 53 demonstrated that the rate of KT evaluation completion decreased precipitously as the number of required tests increased. Because the need for more testing often reflects increased disease burden, it is not surprising that a patient with substantial comorbidities has a more complicated evaluation process with a reduced likelihood of acceptance for KT.…”

Health Disparities in Kidney Transplantation for African Americans

“…Two retrospective studies showed that AAs were less likely to complete a kidney transplant evaluation than CAs [4, 5]. Indeed, reduced access to kidney transplantation is the most serious disparity in ESRD because it limits duration and quality of life.…”

Cultural competency of a mobile, customized patient education tool for improving potential kidney transplant recipients’ knowledge and decision-making

“…[1] Inadequate education may particularly impact patients with lower socioeconomic status or members of racial/ethnic minorities, contributing to lower rates of referral and transplant listing [2][3][4][5][6]. In addition, patients may choose to reject high KDPI and PHS increased risk organs that are expected to provide benefit out of fear or incomplete understanding of the relative risk of death on dialysis.…”