Neighborhood Poverty, Racial Composition and Renal Transplant Waitlist

Abstract

To date, no study has characterized the association between neighborhood poverty, racial composition and deceased donor kidney waitlist. Using the United States Renal Data System data linked to 2000 U.S. Census Data, we examined Whites (n = 152 788) and Blacks (n = 130 300) initiating dialysis between January 2000 and December 2006. Subjects' neighborhoods were divided into nine strata based on the percent of Black residents and percent poverty. Cox proportional hazards were used to determine the association between time to waitlist and neighborhood characteristics after adjusting for demographics and comorbid conditions. Individuals from poorer neighborhoods had a consistently lower likelihood of being waitlisted. This association was synergistic with neighborhood racial composition for Blacks, but not for Whites.

Factors Contributing to Kidney Allograft Loss and Associated Consequences among Post Kidney Transplantation Patients

“…Kidney transplantation is associated with higher quality of life, lower mortality, and lower health care expenditure than haemodialysis or peritoneal dialysis [91]. Despite these findings, there are important differences in rates of transplantation between Whites and Blacks in the United States, while Blacks comprise approximately 32% of those receiving dialysis, they receive approximately 25% of deceased donor kidneys [91].…”

“…Despite these findings, there are important differences in rates of transplantation between Whites and Blacks in the United States, while Blacks comprise approximately 32% of those receiving dialysis, they receive approximately 25% of deceased donor kidneys [91]. Graft failure is associated with racial and ethnic differences that are related to the level of health services, [24,42].…”

“…Graft failure is associated with racial and ethnic differences that are related to the level of health services, [24,42]. Saunders et al [91]; Waterman et al [92] describe three complementary mechanisms that may account for the associations, firstly, Blacks are more likely to live in poor and racially isolated neighbourhoods that are resourcepoor, which may in turn lead to reduced access to transplant waitlists.…”

Standardized Transplantation Referral Ratio to Assess Performance of Transplant Referral among Dialysis Facilities

“…Prior research has attributed poor access to kidney transplantation to gaps along the continuum of care for patients with ESRD (2,3). Although the effects of dialysis facility-and patientlevel factors on waitlisting and transplantation have been studied (2)(3)(4)(5)(6)(7)(8)(9), their effects on earlier steps, such as receiving education about the benefits of transplantation and referral from dialysis facilities to a transplant center for evaluation, have been understudied. With statewide data collection on transplant referral through the Southeastern Kidney Transplant Coalition, we previously reported wide variation in facility referral for kidney transplantation in the state of Georgia, where some facilities referred no patients and others referred up to 76% of their patient population (3).…”

Eventos vitais estressores e lesão renal aguda em centros de terapia semi-intensiva e intensiva

“…[3][4][5][6] The high mortality rate of these pathologies, especially in ICU, brings out the need for attention for this disease. [1][2][3][4][5][6][7] Studies on chronic kidney diseases have shown the importance of ethnical, 8 environmental, 9,10 socioeconomical, [11][12][13][14][15] and psychic factors, modulating the disease, its complications and progonosis. 16 Many investigations have demonstrated that chronic stress conditions are associated with allostatic overload, 17,18 that is, the attempt of the body to find stability through stressful change, thus leading to changes in cortisol and insulin levels, in the hypothalamo-hypophyseal axis (HPA), kinins, and other proinflammatory elements, among other homeostatic changes.…”