Racial disparities in kidney transplant waitlist appearance in Chicago: Is it race or place?

Peng, Robert B.; Lee, Haena; Ke, Zheng Tracy; Saunders, Milda R.

doi:10.1111/ctr.13195

Cited by 17 publications

(11 citation statements)

References 36 publications

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“…Reasons for these differences likely include both genetic predisposition as well as a long-term consequence of structural racism ( Beydoun et al, 2017 ; Parsa et al, 2013 ). Previous studies have observed that residence in predominantly Black neighborhoods is associated with lower rates of transplantation wait-listing ( Arriola, 2017 ; Peng et al, 2018 ). However, less is understood about the relationship of Hispanic ethnicity and CKD, at both an individual and neighborhood level.…”

Section: Discussionmentioning

confidence: 99%

Neighborhood context and kidney disease in Philadelphia

Boyle¹,

Zhao²,

Chou³

et al. 2020

SSM - Population Health

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Neighborhood context might influence the risk of chronic kidney disease (CKD), a condition that impacts approximately 10% of the United States population and is associated with significant morbidity, mortality, and costs. We included a sample of 23,692 individuals in Philadelphia, Pennsylvania, who were seen in a large academic primary care practice between January 1, 2016 and December 31, 2017. We used generalized linear equations to estimate the associations between indicators of neighborhood context (e.g., proximity to healthy foods stores, neighborhood walkability, social capital, crime rate, socioeconomic status) and CKD, adjusted for age, sex, race/ethnicity, and insurance coverage. Among those with CKD, secondary outcomes were poor glycemic control (hemoglobin A1c ≥ 6.5%) and uncontrolled blood pressure (systolic ≥ 140 mm Hg and/or diastolic ≥ 90 mm Hg). The cohort represented residents from 97% of Philadelphia census tracts. CKD prevalence was 10%. When all neighborhood context metrics were considered collectively, only lower neighborhood socioeconomic index (a composite assessment of neighborhood income, educational attainment, and occupation) was associated with a higher risk of CKD (lowest tertile vs. highest tertile: adjusted relative risk [aRR] 1.46 [1.25, 1.69]; mid-tertile vs. highest-tertile: aRR 1.35 [1.25, 1.52]). Among those with CKD, compared to residence in the most walkable neighborhoods (i.e., where most essential resources are accessible by foot), residence in neighborhoods with mid-level WalkScore® (i.e., where only some essential neighborhood resources are accessible by foot) was independently associated with poor glycemic control (aRR 1.20, 95% CI 1.01–1.42). These findings suggest a potential role for measures of neighborhood socioeconomic status in identifying communities that would benefit from screening and treatment for CKD. Studies are also needed to determine mechanisms to explain why residence in neighborhoods not easily navigated by foot or car might hinder glycemic control among people with CKD.

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Section: Discussionmentioning

confidence: 99%

Neighborhood context and kidney disease in Philadelphia

Boyle¹,

Zhao²,

Chou³

et al. 2020

SSM - Population Health

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“…22,23 While more difficult to quantify given that referral and listing rates are not tracked, evidence suggests inequities in access to kidney transplant start prior to listing as well, with factors such as gender, race, ethnicity, socioeconomic status, and health literacy all affecting the likelihood that a patient referred for transplant will subsequently get listed and transplanted. 24 –26…”

Section: Discussionmentioning

confidence: 99%

Identifying Needs and Barriers to Engage Family Members in Transplant Candidate Care

McKinney

Bruin²,

Kurschner

et al. 2021

Prog Transpl

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Introduction: Friends and family members provide critical support to patients on the waitlist for deceased donor kidney transplantation. However, little is known about how best to support and engage them effectively to improve patient outcomes. Methods: We conducted 5 focus groups with the family members of patients on the waitlist for a deceased donor kidney (n=23) to identify individual- and group-level targets for an intervention. Discussions encouraged participants to reflect on their support roles, experiences at the transplant evaluation, interactions with providers, knowledge of transplant options and expected outcomes. Transcripts of study sessions were coded using an iterative and inductive process. Results: The thematic analysis produced two main themes related to experiences providing care to patients on the waitlist for kidney transplantation. First, participants revealed that supporting a patient on the waitlist created challenges that reverberate through their entire social structure. Family members discussed frustrations with adapting to their patient’s kidney health needs, feelings of isolation, and barriers to identifying and building effective support networks. Second, participants described multiple challenges that prevented their patient-family unit from making informed decisions about transplant care. These challenges included communication with their patient, patients resisting help, difficulty understanding the information, and feeling helpless. Conclusion: Family members providing care to patients with end-stage kidney disease require targeted support to overcome the unique challenges associated with their role in helping to meet their patient’s clinical needs. Interventions to engage friends and family members in the care of kidney transplant candidates need to effectively address these challenges.

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“…In a study of United States Renal Data System (USRDS) data, Kucirka et al (2012) found that people were less likely to be listed if they were uninsured, African American or female. A more recent analysis of USRDS data has confirmed that people were less likely to be listed for transplant if they were African American or from a poorer socioeconomic group (Peng et al 2018). United Kingdom Renal Registry data in 2018 found that women were less likely than men to be activated on the renal transplant waiting list within two years of starting dialysis, and different referral patterns between transplanting and non-transplanting units meant that people dialysing at non-transplanting units were less likely to be listed for a transplant (Taylor et al 2018).…”

Section: Literature Reviewmentioning

confidence: 99%

Maximising access to kidney transplantation: A single‐centre audit of people receiving dialysis

Burns

Turner

Brown

2019

Journal of Renal Care

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SUMMARY Background Despite transplantation being well documented as the renal replacement therapy option that gives the best morbidity and mortality outcomes, the best quality of life and the best value for healthcare dollar, not all patients are on a kidney transplant waiting list. Objectives The aims of this study were (1) to explore possible reasons for a demonstrated a higher rate of people being listed as suitable for transplant in a non‐transplanting unit and (2) to describe a formal process of review and referral as a method for maximising the number of people gaining access to the transplant waiting list. Methods We prospectively audited all patients who were undergoing dialysis in our metropolitan, non‐transplanting renal unit annually over six years to determine whether not being on the transplant waiting list was in keeping with available eligibility guidelines of medical and behavioural criteria. Results In every age group, the percentage of patients listed for transplant was higher than that seen in national data. The most common reasons for people not to be listed were malignancy, obesity and cardiovascular disease. This unit's patients had fewer smokers, less females and less Aboriginal and Torres Strait Islanders which may have contributed towards a higher rate of activation on the list. Conclusion In this dialysis patient population having a formal process of review for suitability and referral, as well as a specialist renal transplant coordinator nurse positively affected the number of patients being activated on the transplant waiting list.

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Racial disparities in kidney transplant waitlist appearance in Chicago: Is it race or place?

Abstract: Consistent with national data, African Americans in Chicago have a lower likelihood of waitlisting than whites. This disparity is explained in part by neighborhood poverty, which impacts the majority of African American ESRD patients in Chicago.

Cited by 17 publications

References 36 publications

Neighborhood context and kidney disease in Philadelphia

Neighborhood context and kidney disease in Philadelphia

Identifying Needs and Barriers to Engage Family Members in Transplant Candidate Care

Maximising access to kidney transplantation: A single‐centre audit of people receiving dialysis

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