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Kidney Week

Abstract: PO2487

Racial-Ethnic Disparities in Preemptive Kidney Transplantation Among Incident ESKD Adult Patients, 2006 to 2018

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Baranwal, Navya, Brown University Warren Alpert Medical School, Providence, Rhode Island, United States
  • Thorsness, Rebecca, Brown University School of Public Health, Providence, Rhode Island, United States
  • Swaminathan, Shailender, Brown University School of Public Health, Providence, Rhode Island, United States
  • Patzer, Rachel E., Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, United States
  • Mehrotra, Rajnish, Harborview Medical Center, Seattle, Washington, United States
  • Trivedi, Amal, Brown University School of Public Health, Providence, Rhode Island, United States
Background

Preemptive kidney transplantation (PKT) is the preferred treatment for ESKD. Among kidney transplant recipients, black and Hispanics are less likely to receive PKT than whites, but less is known about disparities in PKT among the entire incident ESKD population. This is a critical gap in knowledge given the Advancing American Kidney Health goal of 80% of all new ESKD patients receiving transplant or home dialysis by 2025. This study assessed racial/ethnic disparities in initial treatment with PKT vs. dialysis among all incident kidney failure patients aged 19-74 from 2006 to 2018.

Methods

Treatment modality for incident ESKD patients was identified using the CMS Medical Evidence Report Form. Linear regression models estimated PKT rates for white, blacks, Hispanics and Asians, adjusting for clinical, geographic, socioeconomic, and access factors.

Results

Among 1,133,326 incident ESKD adult patients, the age/sex adjusted PKT rate declined from 3.0% in 2006 to 2.5% in 2018, with varied trends in each racial/ethnic group (white: 5.0% to 4.0%, black: 0.5% to 0.7%, Hispanic: 1.3% to 1.3%, and Asian: 2.4 to 2.9%) (Figure). In age-sex adjusted analyses, whites had 3.9, 3.2, and 1.7 percentage point higher rates of PKT compared to blacks, Hispanics, and Asians, respectively. These differences persisted after adjusting for clinical, geographic, SES, and pre-ESKD nephrology care (Table). Among patients aged 19-44, whites had 8.0, 6.3, and 3.3 higher rates of PKT, compared to blacks, Hispanics, and Asians.

Conclusion

Among incident ESKD adult patients, racial/ethnic disparities in receipt of PKT are substantial, persistent, and not explained by differences in observed clinical factors and socioeconomic status. Efforts to increase preemptive transplantation must address disparities in access to this preferred treatment for ESKD.

Funding

  • NIDDK Support