Kidney Week

Abstract: SA-PO096

Social Determinants of Quality of Life in Patients Evaluated for Kidney Transplant

Session Information

• Transplantation: Recipient and Donor Assessment
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Wesselman, Hannah, University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Hannah Wesselman,

• Wang, Shu, University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Shu Wang,

• Chang, Chung-Chou H., University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Chung-Chou H. Chang,

• Pleis, John R., VA Pittsburgh, Pittsburgh, Pennsylvania, United States

John R. Pleis,

• Kendall, Kellee, University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Kellee Kendall,

• Croswell, Emilee J., University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Emilee J. Croswell,

• Dew, Mary amanda, University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Mary amanda Dew,

• Unruh, Mark L., University of New Mexico, Los Ranchos, New Mexico, United States

Mark L. Unruh,

• Shapiro, Ron, Recanati/Miller Transplantation Institute, New York, New York, United States

Ron Shapiro,

• Myaskovsky, Larissa, University of New Mexico, Albuquerque, New Mexico, United States

Larissa Myaskovsky,

Background

Non-Hispanic African Americans (AA) have a higher incidence of ESRD but lower rates of kidney transplant (KT), and poorer quality of life (QOL) compared to non-Hispanic whites (WH). Disparities persist after adjusting for medical factors (e.g., comorbidity, dialysis). We assessed whether race disparities in QOL would persist in patients evaluated for KT after adjusting for medical and social determinants, including demographic (e.g., age, income), cultural (e.g., perceived discrimination, medical mistrust), psychosocial (e.g., social support, emotional distress), and knowledge (e.g., knowledge, learning activities) factors.

Methods

We conducted a longitudinal cohort study with 1035 (AA=260; WH=775) patients undergoing KT evaluation at the UPMC Starzl Transplant Institute. Patients completed an interview after initiating KT evaluation to assess social determinants; and another interview after being accepted, rejected, or withdrawing from evaluation, to assess kidney-specific (symptoms/problems, sleep, lifestyle effects, burden, cognitive function, work, sexual function) and general QOL (mental and physical composite scores) using the Kidney Disease QOL scale. We built multivariable regression models to test the hypothesized relationships.

Results

Our sample was 38% female, mean age=57, 73% had family income < $50,000, 52% married, 35% public insurance, 27% private, and 38% public/private. Race differences in kidney-specific QOL outcomes were no longer significant when social determinants were included in the model. Instead, psychosocial (e.g., mastery, social support, emotional distress), transplant knowledge (e.g., concerns, learning activities, knowledge), and demographic (e.g., age, sex, income, insurance) factors were significant predictors. For general QOL outcomes, race continued to be a significant predictor even after we identified several significant psychosocial, transplant knowledge, and demographic predictors (all predictors significant at p<.05).

Conclusion

A combination of social determinants predicted QOL outcomes for KT patients, which mediated race differences, especially for kidney-specific QOL. Transplant centers may help ensure better QOL in their patients as they await KT by promoting psychosocial support, and ensuring candidates’ understanding of KT.

Funding

• NIDDK Support