Abstract: TH-PO533
Consideration of Living Donor Kidney Transplantation across the Continuum of Care in CKD
Session Information
- CKD: Health Services, Disparities, Prevention
November 02, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Chronic Kidney Disease (Non-Dialysis)
- 307 CKD: Health Services, Disparities, Prevention
Authors
- Vilme, Helene, Duke University, School of Medicine, Durham, North Carolina, United States
- Davenport, Clemontina A., Duke University School of Medicine, Durham, North Carolina, United States
- Pendergast, Jane F., Duke University School of Medicine, Durham, North Carolina, United States
- Boulware, L. Ebony, Duke University School of Medicine, Durham, North Carolina, United States
Background
African Americans (AA) have had persistent disparities in achieving live donor kidney transplants (LDKT). It is unclear whether patients’ interest and pursuit of LDKT varies based on their exposures to kidney disease treatments (pre-dialysis, dialysis, and transplant waitlist) and what knowledge or attitudinal factors might affect interest and pursuit among different groups.
Methods
We conducted separate secondary cross-sectional analyses of baseline data collected among AA with advanced kidney disease or kidney failure in three randomized clinical trials studying access to LDKT. Patients were either (1) not previously exposed to renal replacement therapies (‘pre-dialysis’), (2) on hemodialysis, or (3) on the transplant waiting list. We measured participants’ interest in LDKT on a 10-point scale ranging from 0-7 (not interested) to >7(highly interested). We measured patients’ pursuit (present versus absent) of LDKT based on their self-reported discussion of LDKT with their families or physicians, or their completion of an LDKT evaluation. We quantified the association of knowledge, health literacy, and trust with medical care with interest and pursuit in separate multivariable logistic regression models adjusting for age, sex, marital status, and education.
Results
A majority of participants (total N=62 pre-dialysis, N=92 dialysis, N=156 transplant waitlist) in all three cohorts reported having high interest in LDKT (pre-dialysis, 62.9%; dialysis, 67.4%; transplant waitlist, 74.2%). Compared to pre-dialysis patients, those with exposure to dialysis and those on the waiting list more frequently pursued LDKT (pre-dialysis, 45.0%; dialysis, 72.7%; transplant waitlist, 92.2%). No significant association was observed between interest in LDKT, knowledge, health literacy, or the three trust factors for pre-dialysis, dialysis, and transplant waitlist, respectively (p>.05). Similarly, we found no significant association with LDKT pursuit in either of the study cohorts (p>.05).
Conclusion
Progress has been made in assisting African Americans to pursue LDKT. Our study showed that interest in LDKT is high at all stages of treatment, but pursuit is lower at early stages. Efforts are needed to assist individuals with interest in LDKT move towards LDKT pursuant behaviors.
Funding
- NIDDK Support