Despite substantial advances in kidney transplantation, significant racial disparities still exist, with African Americans spending longer periods of time on the transplant waiting list and facing poorer access to living donor kidney transplants (LDKT) than whites. Efforts to encourage African Americans to pursue LDKT at earlier stages of kidney disease might help bridge this gap, a new study suggests.

Although interest in LDKT is high among African Americans at all stages of kidney disease, the actual pursuit of LDKT opportunities remains lower during early disease stages, noted Helene Vilme, DrPH, of Duke University, who presented findings in a poster displayed at the American Society of Nephrology annual meeting held October 31 to November 5, 2017, in New Orleans, LA. Other Duke investigators involved in the study were Clemontina A. Davenport, PhD, Jane F. Pendergast, PhD, and Ebony I. Boulware, MD, MPH.

Dr. Vilme indicated that "interventions to improve the pursuit of LDKT among predialysis patients are needed," explaining that "transplant before dialysis (preemptive) is associated with better graft survival, improved quality of life, and lower medical expenses over time."

Kidney transplantation is considered to be the optimal renal replacement therapy for eligible patients with end-stage renal disease. It offers the best quality of life and the lowest rates of morbidity and mortality. Of note, more than 50% of patients awaiting kidney transplantation in the United States are ethnic minorities, and more than 33% are African Americans.

The researchers conducted separate secondary cross sectional analyses of baseline data collected from African Americans with advanced kidney disease or kidney failure in 3 randomized clinical trials studying access to LDKT. Patients fell into 1 of 3 groups:

1.    Not previously exposed to renal replacement therapies ("pre-dialysis")
2.    On hemodialysis
3.    On the transplant waiting list

Researchers measured subjects' interest in LDKT on a 10-point scale; those selecting 0-7 were classified as "not interested" and those selecting 8-10 were classified as "interested." They also measured the pursuit of LDKT based on patients' self-reported discussions of LDKT with their families or physicians or their completion of an LDKT evaluation. The investigators quantified the association of knowledge, health literacy, and trust in medical care with interest in pursuit and actual pursuit using separate multivariable logistic regression models that adjusted for age, sex, marital status, and education.

A majority of participants in all 3 groups reported having a high interest in LDKT. Those with exposure to dialysis and those on the waiting list more frequently made tangible efforts to pursue LDKT than pre-dialysis patients.

The presenters concluded that more research is needed to identify modifiable factors that can improve early pursuit of LDKT among African Americans. 

Source: Vilme H, Davenport CA, Pendergast JF, Boulware EL. Consideration of living donor kidney transplantation across the continuum of care in CKD. Presented at: American Society of Nephrology Annual Meeting, Kidney Week 2017; October 31-November 5, 2017; New Orleans, LA. Poster 533.