Non-medical barriers in access to early steps of kidney transplantation in the United States – A scoping review

Harding, Jessica L.; Perez, Aubriana; Snow, Kylie; Retzloff, Samantha; Urbanski, Megan; White, Mia S.; Patzer, Rachel E.

doi:10.1016/j.trre.2021.100654

Cited by 28 publications

(30 citation statements)

References 65 publications

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“…Outside our own work, 33 , 34 , 46 , 47 , 48 findings that women have reduced access to early transplant steps have been demonstrated in several other studies. For example, in a national Canadian study of >13,000 people who initiated dialysis between 2010 and 2013, female sex was associated with a 12% reduced likelihood of transplant referral.…”

Section: Discussionsupporting

confidence: 64%

Gender Disparities in Kidney Transplantation Referral Vary by Age and Race: A Multiregional Cohort Study in the Southeast United States

Smothers

Patzer

Pastan

et al. 2022

Kidney International Reports

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Section: Discussionsupporting

confidence: 64%

Gender Disparities in Kidney Transplantation Referral Vary by Age and Race: A Multiregional Cohort Study in the Southeast United States

Smothers

Patzer

Pastan

et al. 2022

Kidney International Reports

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“…Our findings are aligned with early analyses of the effect of KAS, which found that racial disparities in access to deceased donor transplantation were substantially reduced after KAS implementation 3,4 and were at least temporarily eliminated during the years 2015-2019 among patients already waitlisted. 12 However, substantial racial disparities remain in access to the waiting list, [12][13][14] including evaluation start 15,16 and living donor transplant. 14 Other system-level interventions targeting dialysis facilities have improved the quality of care for patients.…”

Section: Discussionmentioning

confidence: 99%

The ASCENT Intervention to Improve Access and Reduce Racial Inequalities in Kidney Waitlisting

Patzer

Zhang

Buford

et al. 2023

CJASN

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Background The US kidney allocation system (KAS) changed in 2014, but dialysis facility staff (including nephrologists, social workers, nurse managers, and facility administrators) had low awareness of how this policy change could affect their patients' access to transplant. We assessed the effectiveness of a multicomponent and multilevel educational and outreach intervention targeting US dialysis facilities with low waitlisting, with a goal of increasing waitlisting and reducing Black versus White racial disparities in waitlisting. MethodsThe Allocation System Changes for Equity in Kidney Transplantation (ASCENT) study was a clusterrandomized, pragmatic, multilevel, effectiveness-implementation trial including 655 US dialysis facilities with low waitlisting, randomized to receive either the ASCENT intervention (a performance feedback report, a webinar, and staff and patient educational videos) or an educational brochure. Absolute and relative differences in coprimary outcomes (1-year waitlisting and racial differences in waitlisting) were reported among incident and prevalent patients.Results Among 56,332 prevalent patients, 1-year waitlisting decreased for patients in control facilities (2.72%-2.56%) and remained the same for patients in intervention facilities (2.68%-2.75%). However, the proportion of prevalent Black patients waitlisted in the ASCENT interventions increased from baseline to 1 year (2.52%-2.78%), whereas it remained the same for White patients in the ASCENT intervention facilities (2.66%-2.69%). Among incident patients in ASCENT facilities, 1-year waitlisting increased among Black patients (from 0.87% to 1.07%) but declined among White patients (from 1.54% to 1.27%). Significant racial disparities in waitlisting were observed at baseline, with incident Black patients in ASCENT facilities less likely to waitlist compared with White patients (adjusted odds ratio [aOR], 0.56; 95% confidence interval [CI], 0.35 to 0.92), but 1 year after the intervention, this racial disparity was attenuated (aOR, 0.84; 95% CI, 0.49 to 1.42). ConclusionsThe ASCENT intervention may have a small effect on extending the reach of the new KAS policy by attenuating racial disparities in waitlisting among a population of US dialysis facilities with low waitlisting.

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“…Numerous studies have investigated racial disparities in access to kidney transplantation [10,17,26]. Harding et al [4], Patzer and McClellan [27] and Patzer et al [28] documented that racial disparities were strongly associated with socioeconomic status and independently associated with each step of the pathway from registration to transplantation. Hamoda et al [8] suggested that medical mistrust, previously experienced discrimination and perceived racism were associated with a decreased evaluation for transplantation initiation.…”

Section: Discussionmentioning

confidence: 99%

“…In high-income countries, there are disparities in access to the KTWL due to geographic, demographic and socioeconomic factors [3,4]. It is also well known that there are important disparities between countries, as in many low-income countries there is no or very difficult access to kidney transplantation [5].…”

Section: Introductionmentioning

confidence: 99%

Perception of social inequities in the access to the kidney transplant waiting list by nephrology trainees: a national survey

et al. 2022

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Background Social inequalities in health are responsible for disparities in access to the kidney transplant waiting list (KTWL). The perception of disparities by nephrologists has consequences for the registration on the KTWL. The purposes of our study were to assess the perception of the factors implicated in the disparities in access to the KTWL by nephrology trainees and to assess the quality of the questionnaire. Methods A questionnaire was developed to assess the perception of the determinants of the inequities in access to waitlisting. Continuous variables were described by median, 1st and 3rd quartiles. Categorical variables were described by frequencies and percentages. A principal component analysis and a hierarchical cluster analysis were performed to approach the correlation between the variables. A scree plot and a factor analysis were performed to determine the dimensions of the questionnaire. The internal consistency was estimated by Cronbach’s coefficient. Results The response rate was 98/110 (89%). The determinants of inequities in the access to KTWL not perceived by the nephrology trainees were “female sex”, “income level” and “the centre provision to adapt the information to all of the patients” (18,3%, 36,7, 47% respectively). “Age”, “being born abroad”, “place of living”, “education level”, “transplant centre”, “the health care provider” were determinants of disparities perceived by most of the trainees (85,7%, 75,5%, 82,6%, 78,6%, 73,5% et 78,5% respectively). Items related to the transplant centre were positively correlated, as well as “being born abroad”, “education level” and “income level”. The Cronbach’s coefficient was 0,60. Conclusion Social inequalities in health are partially perceived by nephrology trainees. A teaching session could raise nephrologists’ awareness of this issue and could help reduce the impact of these disparities on the course of ESKD (end-stage kidney disease) patients.

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Non-medical barriers in access to early steps of kidney transplantation in the United States – A scoping review

Cited by 28 publications

References 65 publications

Gender Disparities in Kidney Transplantation Referral Vary by Age and Race: A Multiregional Cohort Study in the Southeast United States

Gender Disparities in Kidney Transplantation Referral Vary by Age and Race: A Multiregional Cohort Study in the Southeast United States

The ASCENT Intervention to Improve Access and Reduce Racial Inequalities in Kidney Waitlisting

Perception of social inequities in the access to the kidney transplant waiting list by nephrology trainees: a national survey

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