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Abstract: FR-PO877

Black Americans Experience a Disproportionately Longer Wait Time for Kidney Transplant

Session Information

Category: Diversity and Equity in Kidney Health

  • 800 Diversity and Equity in Kidney Health


  • Fagan, Jack Ryan, Avalere Health, Washington, District of Columbia, United States
  • Belowich, Emily, Avalere Health, Washington, District of Columbia, United States
  • Labson, Daniel, Avalere Health, Washington, District of Columbia, United States
  • Gooding, Mark John, Avalere Health, Washington, District of Columbia, United States
  • Parekh, Shalini, Avalere Health, Washington, District of Columbia, United States

Almost 786,000 individuals in the United States are living with End-Stage Renal Disease (ESRD), and Black Americans show a three-to-four-fold excess risk in incidence rates. To experience higher survival rates and an optimal quality of life, a kidney transplant is needed to live.


We used 100% Medicare Fee-For-Service (FFS) claims data to identify patients who received a kidney transplant between July 2018 to June 2021. Among these patients, we identified individuals with an initial diagnosis of chronic kidney disease (CKD) or ESRD and were enrolled in Medicare FFS continuously in the year prior to diagnosis to confirm a negative diagnosis period. Beneficiaries entitled to Medicare due to ESRD were excluded to ensure full claims history to capture initial diagnosis, resulting in a total of 3,894 patients. For these patients, we evaluated the time between CKD/ESRD diagnosis and transplantation. Separately, we evaluated the total mortality in the years following either an initial CKD or ESRD diagnosis, excluding patients who received a kidney transplant. Mortality was established utilizing certificate of death data that was identified in Medicare FFS Master Beneficiary Summary File, indexed to diagnosis to establish time to death and subsequent mortality rate by year.


The average wait time for Medicare FFS beneficiaries from time of initial diagnosis of CKD/ESRD to receipt of a kidney transplant was 4.46 years. Compared to all patients, Black Medicare FFS beneficiaries had a longer average wait time from diagnosis to transplant of 5.09 years (P < .0001). Mortality for all patients 4 years post initial diagnosis of CKD/ESRD was 5.03%, and then increased to 6.03% for 5 years, 27.05% for 6 years or greater, with a total mortality of 47.18% for patients 6+ years after CKD/ESRD diagnosis.


Black patients, on average, wait an additional 7.56 months to access a transplantation compared to the average patient. These findings underscore the importance of treatment education and timely access to transplantation as CKD/ESRD mortality increases dramatically with time from 2.54% of patients expiring within one year following diagnosis to a cumulative 47.18% of patients expiring 6 years post diagnosis.