Study Highlights Disparities in Access to Kidney Transplantation Based on Race, Ethnicity

Maya Clark-Cutaia, RN, MSN, PhD

Credit: University of Pennsylvania Nursing

Results from a retrospective study are calling attention to disparities in access to kidney transplants among minoritized patients with end-stage kidney disease (ESKD), highlighting differences in waitlisting and eventual transplantation based on race and ethnicity.

Presented at the American Society of Nephrology Kidney Week 2023, data from the study showed White candidates were more likely to be waitlisted and transplanted than candidates of other racial and ethnic groups, further highlighting greater living donor transplantation among White patients.¹

“There’s a huge disparity when it comes to planning, prevention, and a proactive approach to kidney disease in minoritized populations that we really need to pay attention to,” said Maya Clark-Cutaia, RN, MSN, PhD, assistant professor of nursing at New York University Rory Meyers College of Nursing in an interview with HCPLive Nephrology.

Kidney transplants are necessary for patients experiencing kidney failure. Without dialysis or a transplant, the condition is fatal. However, dialysis is not a permanent solution to kidney failure because although it is effective for clearing waste and excess fluid from the bloodstream, it does not fully replace all kidney function. Kidney transplantation offers most patients a better quality of life and a longer life expectancy compared to those who receive dialysis. However, disparities in access to transplantation inhibit certain patients from receiving adequate care.^2,3

To assess disparities from ESKD diagnosis to listing and first kidney transplant, Clark-Cutaia and a team of investigators collected data for 2,200,356 adults with an ESKD diagnosis between 1999 and 2019 from the United States Renal Data System. Using Fine and Gray sub-distribution hazards models adjusted for age, sex, race/ethnicity, comorbidities, primary health insurance, investigators determined adjusted sub-hazards ratio (aSHR) of listing after ESKD diagnosis and transplantation after listing, using death as a competing risk. The proportional hazards assumption was tested using complementary log-log plots and Schoenfeld residuals.¹

Upon analysis, White candidates were more likely to be waitlisted than Black (aSHR, 0.73; 95% confidence interval [CI], 0.73-0.74), Hispanic (aSHR, 0.74; 95% CI, 0.73-0.74), and Asian (aSHR, 0.77; 95% CI, 0.76-0.78) patients. Investigators pointed out waitlisted White candidates were more likely to receive a kidney transplant, especially from a living donor and preemptively, compared to other racial and ethnic groups:

• Black patients (aSHR, 0.33; 95% CI, 0.32-0.35 for living donor transplant; aSHR, 0.53; 95% CI, 0.47-0.60 for preemptive transplant)
• Hispanic patients (aSHR, 0.66; 95% CI, 0.64-0.69 for living donor transplant; aSHR, 0.65; 95% CI, 0.56-0.75 for preemptive transplant)
• Asian patients (aSHR, 0.45; 95% CI, 0.42-0.47 for living donor transplant; aSHR, 0.47; 95% CI, 0.38-0.58 for preemptive transplant)

“The initial conversations about educating patients about transplantation are important, but then each touchpoint after that is just as significant for really understanding the social determinants of health that are available to these patients to ensure that they remain active on the waitlist. Trying to figure out how best to do that and make sure that it’s tailored to a specific group or specific individual is where we should really be focusing our attention,” Clark-Cutaia concluded.

References:

1. Clark-Cutaia MN, Menon G, Li Y, et al. Disparities in Access to Kidney Transplantation for Asian, Hispanic, and Black Candidates. Paper Presented at: American Society of Nephrology Kidney Week 2023. November 1-5, 2023.
2. Cleveland Clinic. Kidney Failure. Diseases & Conditions. October 4, 2022. Accessed November 4, 2023. https://my.clevelandclinic.org/health/diseases/17689-kidney-failure
3. Cleveland Clinic. Kidney Transplant. Treatments & Procedures. March 14, 2022. Accessed November 4, 2023. https://my.clevelandclinic.org/health/treatments/22537-kidney-transplant