1
|
Mathur AK, Goodrich N, Hong B, Smith AR, Mandell RJ, Warren PH, Gifford KA, Ojo AO, Merion RM. Use of Federal Reimbursement for Living Donor Costs by Racial and Ethnic Minorities: Implications for Disparities in Access to Living Donor Transplantation. Transplantation 2024:00007890-990000000-00758. [PMID: 38771064 DOI: 10.1097/tp.0000000000005013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Minority race, ethnicity, and financial barriers are associated with lower rates of living donor (LD) kidney transplantation (LDKT). Financial reimbursement for LD costs may impact social determinants of health and, therefore, impact disparities in access to LDKT. METHODS Among US LDKTs, we studied associations between racial and ethnic minority status and utilization of the National Living Donor Assistance Center (NLDAC), a means-tested reimbursement program for nonmedical LD costs. We analyzed demographic, clinical, income, and survey data from NLDAC and the Scientific Registry of Transplant Recipients (January 1, 2011, to December 31, 2022) to identify predictors of NLDAC utilization. RESULTS Among 70 069 US LDKTs, 6093 NLDAC applicants were identified (9% of US LDKTs). Racial and ethnic minorities were over-represented in NLDAC-supported LDKTs compared with non-NLDAC US LDKTs (Black donors 12% versus 9%; Black recipients 15% versus 12%; Hispanic donors 21% versus 14%; Hispanic recipients 23% versus 15%; all P < 0.001). Among preemptive transplants, use of NLDAC by donors to Hispanic recipients (11%) was nearly twice as high as that of non-Hispanic recipients (6%) (P < 0.001). At time of NLDAC application, 72% stated NLDAC "will make it possible" to donate; higher proportions of minority applicants agreed (Black 80%, White 70%, P < 0.001; Hispanic 79%, non-Hispanic 70%, P < 0.001). Racial and ethnic minority-concordant transplants were significantly more likely to use NLDAC (donor/recipient: Black/Black risk-adjusted odds ratio [OR], 1.85, other/other OR 2.59, Hispanic/Hispanic OR 1.53; all P < 0.05). CONCLUSIONS Reduction of LD financial barriers may increase access to LDKT, particularly in racial and ethnic minority communities.
Collapse
Affiliation(s)
- Amit K Mathur
- Division of Transplant Surgery, Mayo Clinic in Arizona, Phoenix, AZ
| | | | - Barry Hong
- Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Abigail R Smith
- Arbor Research Collaborative for Health, Ann Arbor, MI
- Division of Biostatistics, Department of Preventative Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | | | | | | | | |
Collapse
|
2
|
Loban K, Morgan R, Kute V, Bhalla AK, Sandal S. Are Differences in Living Kidney Donation Rates a Sex or a Gender Disparity? EXP CLIN TRANSPLANT 2024; 22:28-36. [PMID: 38385370 DOI: 10.6002/ect.mesot2023.l21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Sex-disaggregated data reveal significant disparities in living kidney donation, with more female than male living kidney donors in most countries and proportions over 60% in some countries. We summarize the present state of knowledge with respect to the potential drivers of this disparity and argue that it is primarily driven by gender-related factors. First, we present the differences between sex and gender and then proceed to summarize the potential medical reasons that have been proposed to explain why males are less likely to be living kidney donors than females, such as the higher prevalence of kidney failure in males. We then present counterarguments as to why biological sex differences are not enough to explain lower living kidney donation among males, such as a higher prevalence of chronic kidney disease among females, which could affect donation rates. We argue that gender differences likely provide a better explanation as to why there are more women than men living kidney donors and explore the role of economic and social factors, as well as gender roles and expectations, in affecting living kidney donation among both men and women. We conclude with the need for a gender analysis to explain this complex psychosocial phenomenon in living kidney donation.
Collapse
Affiliation(s)
- Katya Loban
- From the Research Institute of the McGill University Health Centre and the Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | | | | | | | | |
Collapse
|
3
|
Artan AS, Fleetwood V, Guller N, Oto OA, Mirioglu S, Yazici H, Turkmen A, Caliskan Y, Lentine KL. Pregnancy in Living Kidney Donors: An Evidence-Based Review. CURRENT TRANSPLANTATION REPORTS 2023; 10:110-116. [PMID: 37743976 PMCID: PMC10512453 DOI: 10.1007/s40472-023-00402-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 09/26/2023]
Abstract
Purpose of review To review the current studies and guidelines on the risk of adverse pregnancy outcomes in female kidney donors. Recent findings Living kidney donors include a significant amount of young women of child-bearing age. Safety and possible risks of pregnancy after donation are a concern for female kidney donor candidates. Many current studies indicate a higher risk of preeclampsia in women after kidney donation. Considering the increasing number of living kidney donors, the maternal outcomes of living kidney donation is an active area of research. Summary Guidelines and consensus statements on the risk of pregnancy in living kidney donors recommend close monitoring of blood pressure, weight gain, and proteinuria during pregnancy. Current studies indicate an increased risk of hypertensive disorders of pregnancy in living kidney donors. Counseling and informing donor candidates about the possible risks is important.
Collapse
Affiliation(s)
- Ayse Serra Artan
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Vidyaratna Fleetwood
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Nurane Guller
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ozgur Akin Oto
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Safak Mirioglu
- Division of Nephrology, Department of Internal Medicine, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Halil Yazici
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Yasar Caliskan
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Krista L. Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, Saint Louis, MO, USA
| |
Collapse
|
4
|
Bhargava R, Chauhan R, Tiwari AK, Mehra S, Pabbi S, Aggarwal G, Sharma V, Bhardwaj V. Real-world data on renal transplantations from a tertiary-care hospital in North India, in context of Indian regulatory act-transplantation of human organs and tissues act (THOTA): A retrospective analysis. Transpl Immunol 2023; 78:101802. [PMID: 36868325 DOI: 10.1016/j.trim.2023.101802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/23/2023] [Accepted: 02/21/2023] [Indexed: 03/05/2023]
Abstract
INTRODUCTION Renal transplantation is the treatment of choice for patients suffering from end stage renal disease (ESRD). Indian regulations defined under Transplantation of Human Organs and Tissues Act (THOTA), 2014 restricts organ donations to near-related living donors to curb any malpractices like 'paid donors' in living-donor kidney transplantation (LDKT). The aim of our study was to look at real-world data of donor-recipient pairs and to identify relationship of donors (with their respective patients) and the common (or uncommon) DNA profiling methods used for supporting "claimed relationship" in accordance with the regulations. MATERIAL AND METHODS The donors were categorized and grouped into near-related donor, donors other than near-related donors, swap donors and deceased donors. Claimed relationship was confirmed, commonly by HLA typing, using SSOP method. In few cases, which were uncommon (and infrequent), autosomal DNA analysis, mitochondrial DNA analysis and Y-STR DNA analysis were performed to support the claimed relationship. Data collected included age, gender, relationship, DNA profiling test method. RESULTS Among the 514 donor-recipient pairs evaluated, numbers of female donors out-numbered male donors. The decreasing order of relationships in near-related donor group were wife>mother>father>sister>son>brother>husband> daughter>grandmother. 11.9% of donors were in the category of donors other than near-related donors. In 97.86% cases, the claimed relationship was supported by HLA typing and in just 2.1% cases autosomal DNA analysis>mitochondrial DNA analysis> Y-STR DNA analysis, in this order, were performed to establish relationship. CONCLUSION This study brought out gender disparity with women out-numbering men as donors. Among recipients, access to renal transplant was largely restricted to men. As far as relationship of donors to recipients was concerned, mostly near-related family members, like wife, were donors and claimed relationship was almost always (99%) was corroborated by HLA typing.
Collapse
Affiliation(s)
- Riya Bhargava
- Molecular and Transplant Immunology Laboratory, Department of Transfusion Medicine, Medanta-The Medicity, Gurgaon, India
| | - Rajni Chauhan
- Molecular and Transplant Immunology Laboratory, Department of Transfusion Medicine, Medanta-The Medicity, Gurgaon, India.
| | - Aseem Kumar Tiwari
- Molecular and Transplant Immunology Laboratory, Department of Transfusion Medicine, Medanta-The Medicity, Gurgaon, India
| | - Simmi Mehra
- Molecular and Transplant Immunology Laboratory, Department of Transfusion Medicine, Medanta-The Medicity, Gurgaon, India
| | - Swati Pabbi
- Molecular and Transplant Immunology Laboratory, Department of Transfusion Medicine, Medanta-The Medicity, Gurgaon, India
| | - Geet Aggarwal
- Molecular and Transplant Immunology Laboratory, Department of Transfusion Medicine, Medanta-The Medicity, Gurgaon, India
| | - Vishal Sharma
- Molecular and Transplant Immunology Laboratory, Department of Transfusion Medicine, Medanta-The Medicity, Gurgaon, India
| | - Vaishali Bhardwaj
- Molecular and Transplant Immunology Laboratory, Department of Transfusion Medicine, Medanta-The Medicity, Gurgaon, India
| |
Collapse
|
5
|
Salas MAP, Chua E, Rossi A, Shah S, Katz-Greenberg G, Coscia L, Sawinski D, Adey D. Sex and gender disparity in kidney transplantation: Historical and future perspectives. Clin Transplant 2022; 36:e14814. [PMID: 36097741 PMCID: PMC10069947 DOI: 10.1111/ctr.14814] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/22/2022] [Accepted: 08/29/2022] [Indexed: 12/27/2022]
Abstract
Sex and gender disparity exist in various stages of kidney transplantation. Females were found to be less likely to be referred for kidney transplant, complete pre-transplant evaluation, be placed on the waitlist, and receive a kidney transplant compared to their male counterparts. Interestingly, females comprise the majority of living kidney donors. This review explores the biological and psychosocial factors that contribute to sex and gender disparity in kidney transplantation and proposes ways to address the disparity.
Collapse
Affiliation(s)
- Maria Aurora Posadas Salas
- Department of Medicine, Division of Nephrology and Hypertension, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Elizabeth Chua
- Renal Associates of Montgomery, Montgomery, Alabama, USA
| | - Ana Rossi
- Piedmont Transplant Institute, Atlanta, Georgia, USA
| | - Silvi Shah
- Division of Nephrology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Goni Katz-Greenberg
- Department of Medicine, Division of Nephrology, Duke University, Durham, North Carolina, USA
| | - Lisa Coscia
- Transplant Pregnancy Registry International, Philadelphia, Pennsylvania, USA
| | - Deirdre Sawinski
- Department of Medicine, Division of Nephrology, Weill Cornell Medicine, New York, New York, USA
| | - Deborah Adey
- Department of Medicine, Division of Nephrology, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
6
|
Characteristics of Potential and Actual Living Kidney Donors: A Single-center Experience. Transplantation 2022; 107:941-951. [PMID: 36476994 DOI: 10.1097/tp.0000000000004357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND There are limited data and no national capture of barriers associated with initiating and completing the donation process for potential living kidney donors (LKDs). METHODS We performed a retrospective analysis of 3001 intake forms completed by prospective LKDs from 2016 to 2019 at a single transplant center. We analyzed data from all potential donors who completed the intake until they became ineligible or withdrew or donation was complete. We used univariate and multivariate models to evaluate independent factors associated with donation at various stages in the donation process. RESULTS The donation process was deconstructed into 5 steps: intake form, immunologic compatibility testing, clinic evaluation, selection committee review, and donation. The highest percentage of potential donors dropped out after completing the intake form, primarily because of not responding to the follow-up phone call (22.6%). Of 455 potential LKDs that completed immunologic compatibility testing, 36% were ABO or crossmatch incompatible. One-hundred eighty-eight (7.5%) of all LKD applicants reached donation, the majority of whom were White (91.0%) and female (63.8%). CONCLUSIONS A minority of LKD applicants make it to donation. Our ability to track all potential LKDs from the initial touch point to the transplant center will help us develop interventions to address barriers to a successful donation.
Collapse
|
7
|
Sancho A, Gavela E, Kanter J, Beltrán S, Castro C, Escudero V, Pantoja J, Molina P, Vizcaíno B, González M, Calatayud E, Avila A. Graft survival differences in kidney transplants related to recipient sex and age. Front Med (Lausanne) 2022; 9:962094. [PMID: 36226149 PMCID: PMC9548586 DOI: 10.3389/fmed.2022.962094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 09/05/2022] [Indexed: 12/02/2022] Open
Abstract
Background In recent years, there has been increasing interest in studying differences in recipient sex in renal disease treatment, access to renal replacement therapy, and subsequent outcomes. Our aim was to find out whether there are differences in outcomes after renal transplantation between female and male kidney transplant recipients in our series, particularly in adults under 60 years of age during long-term follow-up. Methods This was a retrospective study of our kidney transplant series (n = 1,101) to compare graft survival depending on the sex of the recipient in the entire series and patients < 60 years of age (n = 687) during long-term follow-up. Results We observed no association between recipient sex and graft survival throughout the series, regardless of recipient sex. However, adult female recipients under 60 years of age had lower graft survival than male recipients (p = 0.040). Pre-transplant sensitization (HR 2.438, p = 0.002) and donor age (HR: 1.021, p = 0.017) were the independent variables associated with graft failure. Conclusion Female recipients younger than 60 years of age had lower graft survival than male recipients, although there were no gender differences in graft or patient survival in the overall study population. Recipient sex per se was not related to graft failure, but the greater immunological risk in women and more frequent use of expanded criteria donors in female recipients under 60 years of age were the main factors related to their poorer graft survival. Further studies and new strategies are needed to identify these differences and develop the best approach to address them.
Collapse
Affiliation(s)
- Asuncion Sancho
- Department of Nephrology, Hospital Universitari Dr Peset, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Valencia, Spain
- *Correspondence: Asuncion Sancho,
| | - Eva Gavela
- Department of Nephrology, Hospital Universitari Dr Peset, Valencia, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Valencia, Spain
| | - Julia Kanter
- Department of Nephrology, Hospital Universitari Dr Peset, Valencia, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Valencia, Spain
| | - Sandra Beltrán
- Department of Nephrology, Hospital Universitari Dr Peset, Valencia, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Valencia, Spain
| | - Cristina Castro
- Department of Nephrology, Hospital Universitari Dr Peset, Valencia, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Valencia, Spain
| | - Verónica Escudero
- Department of Nephrology, Hospital Universitari Dr Peset, Valencia, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Valencia, Spain
| | - Jonay Pantoja
- Department of Nephrology, Hospital Universitari Dr Peset, Valencia, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Valencia, Spain
| | - Pablo Molina
- Department of Nephrology, Hospital Universitari Dr Peset, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Valencia, Spain
| | - Belen Vizcaíno
- Department of Nephrology, Hospital Universitari Dr Peset, Valencia, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Valencia, Spain
| | - Mercedes González
- Department of Nephrology, Hospital Universitari Dr Peset, Valencia, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Valencia, Spain
| | - Emma Calatayud
- Department of Nephrology, Hospital Universitari Dr Peset, Valencia, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Valencia, Spain
| | - Ana Avila
- Department of Nephrology, Hospital Universitari Dr Peset, Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (Fisabio), Valencia, Spain
| |
Collapse
|
8
|
Zazoulina J, Khehra K, Gill J. Motivators and Barriers to Living Donor Kidney Transplant as Perceived by Past and Potential Donors. Can J Kidney Health Dis 2022; 9:20543581221137179. [PMID: 36419528 PMCID: PMC9677302 DOI: 10.1177/20543581221137179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/29/2022] [Indexed: 11/21/2022] Open
Abstract
Background: For patients with end-stage kidney disease, living donor kidney transplant is
the treatment of choice due to improved patient outcomes, longer graft
survival, and reduced expenses compared with other forms of renal
replacement therapy. However, organ shortage remains a challenge, and living
donation rates have stagnated in recent years, particularly among men. Objective: To understand the motivators and barriers for past and potential living
kidney transplant donors and inform policy and practice changes that support
donors in the future. Methods: Past and potential living donors in British Columbia, Canada in the preceding
2 years were surveyed. Motivators and barriers were examined in 5
categories: family pressures and domestic responsibilities, finances, the
recovery process, complications, and the transplant evaluation process.
Participants ranked statements in each category on a Likert-type scale. Results: A total of 138 responses were collected. In both women and men, policies that
address family and domestic responsibilities and finances were most strongly
identified as motivators to donate. A large proportion of women and men
reported that guaranteed job security (47% women and 38% of men), paid time
off (51% of women and 42% of men), reimbursement of lost wages (49% of women
and 38% of men), and protections to guarantee no impact on future
insurability (62% of women and 52% of men) were significant motivators to
donate. Timely and efficient medical evaluation was considered to be an
important motivator for donation, with 52% of men and 43% of women reporting
support for a “fast-track” option for evaluation to allow for a more rapid
evaluation process. Median barrier and motivator scores were similar between
women and men. Conclusion: Policies to decrease financial burden, ensure job security, improve childcare
support, and offer a fast-track medical evaluation may motivate potential
living kidney donors, irrespective of gender.
Collapse
Affiliation(s)
| | - Keesha Khehra
- The University of British Columbia, Vancouver, Canada
| | - Jagbir Gill
- The University of British Columbia, Vancouver, Canada
| |
Collapse
|
9
|
Abstract
PURPOSE OF REVIEW Living organ donation provides improved access to transplantation, thereby shortening transplant wait times and allowing for more deceased organ transplants. However, disparity in access to living donation has resulted in decreased rates of living donor transplants for some populations of patients. RECENT FINDINGS Though there have been marked improvements in deceased donor equity, there are still challenges as it relates to gender, racial/ethnic, and socio-economic disparity. Improvements in living donation rates in Hispanic and Asian populations are tempered by challenges in African American rates of organ donation. Socio-economic disparity may drive gender disparities in organ donation resulting in disproportionate female living donors. Tailored approaches relating to language-specific interventions as well as directed educational efforts have helped mitigate disparity. Additionally, the use of apolipoprotein1 testing and modifications of glomerular filtration rate calculators may improve rates of African American donation. This review will evaluate recent data in living donor disparity as well as highlight successes in mitigating disparity. SUMMARY Though there are still challenges in living donor disparity, many efforts at tailoring education and access as well as modifying living donor evaluation and identifying systemic policy changes may result in improvements in living donation rates.
Collapse
Affiliation(s)
- Reynold I Lopez-Soler
- Section of Renal Transplantation, Edward Hines VA Jr. Hospital, Hines
- Department of Surgery, Division of Intra-Abdominal Transplantation, Stritch School of Medicine, Maywood, Illinois, USA
| | - Raquel Garcia-Roca
- Department of Surgery, Division of Intra-Abdominal Transplantation, Stritch School of Medicine, Maywood, Illinois, USA
| | - David D Lee
- Department of Surgery, Division of Intra-Abdominal Transplantation, Stritch School of Medicine, Maywood, Illinois, USA
| |
Collapse
|
10
|
Mathur AK, Hong BA, Goodrich NP, Xing J, Warren PH, Gifford KA, Merion RM, Ojo AO. Satisfaction with life and depressive symptoms in living organ donors and non‐donors: New insights from the National Living Donor Assistance Center. Clin Transplant 2020; 34:e13838. [DOI: 10.1111/ctr.13838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 02/06/2020] [Accepted: 02/16/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Amit K. Mathur
- Transplant Surgery Mayo Clinic Phoenix AZ USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic Phoenix Phoenix AZ USA
| | - Barry A. Hong
- Psychiatric Washington University School of Medicine St. Louis MO USA
| | | | - Jiawei Xing
- Arbor Research Collaborative for Health Ann Arbor MI USA
| | | | | | | | - Akinlolu O. Ojo
- Medical School Administration, University of Kansas School of Medicine Kansas KS USA
| |
Collapse
|
11
|
Abstract
PURPOSE OF REVIEW Despite evidence of gender-specific differences in epidemiology and outcomes in all stages of chronic kidney disease (CKD), most studies ignore the issue of gender. This review addresses this knowledge gap by evaluating data on gender disparity in this population. RECENT FINDINGS Population-based studies indicate a higher prevalence of CKD in women; however, there are fewer women on renal replacement therapy than men. Men may progress to end-stage kidney disease more rapidly. Gender differences in rates of CKD progression may be influenced by potential antifibrotic and antiapoptotic effects of estrogen or proinflammatory deleterious effects of testosterone. Women are referred later for kidney replacement therapy and receive fewer arteriovenous fistulas than men receive, irrespective of race. Women are also less likely to receive kidney transplants as compared with men but are more likely to donate a kidney. SUMMARY Recommendations for medical management of CKD patients are currently made in a gender-blind manner, despite the fact that women have differing underlying physiology. Addressing gender differences and disparities is an important and overlooked area in the care of patients with kidney disease.
Collapse
|
12
|
|
13
|
Yoo KD, Lee H, Kim Y, Park S, Park JS, Hong JS, Jeong CW, Kim HH, Lee JP, Kim DK, Oh KH, Joo KW, Kim YS. Maternal and fetal outcomes of pregnancies in kidney donors: A 30-year comparative analysis of matched non-donors in a single center. Kidney Res Clin Pract 2018; 37:356-365. [PMID: 30619691 PMCID: PMC6312783 DOI: 10.23876/j.krcp.18.0050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/24/2018] [Accepted: 10/05/2018] [Indexed: 11/20/2022] Open
Abstract
Background Woman kidney donors face obstetric complication risks after kidney donation, such as gestational hypertension and preeclampsia. Studies on childbirth-related complications among Asian women donors are scarce. Methods This retrospective cohort study included woman donors aged 45 years or younger at the time of kidney donation in a single tertiary hospital between 1985 and 2014. Pregnancy associated complications were investigated using medical records and telephone questionnaires for 426 pregnancies among 225 donors. Matched non-donor controls were selected by propensity score and the maternal and fetal outcomes were compared with those of donors. Primary outcomes were differences in maternal complications, and secondary outcomes were fetal outcomes in pregnancies of the donor and control groups. Results A total of 56 cases had post-donation pregnancies. The post-donation pregnancies group was younger at the time of donation and older at the time of delivery than the pre-donation pregnancies group, and there were no differences in primary outcomes between the groups except the proportion receiving cesarean section. Comparison of the complication risk between post-donation pregnancies and non-donor matched controls showed no significant differences in gestational hypertension, preeclampsia, or composite outcomes after propensity score matching including age at delivery, era at pregnancy, systolic blood pressure, body weight, and estimated glomerular filtration ratio (odds ratio, 0.63; 95% confidence interval, 0.19–2.14; P = 0.724). Conclusion This study revealed that maternal and fetal outcomes between woman kidney donors and non-donor matched controls were comparable. Studies with general population pregnancy controls are warranted to compare pregnancy outcomes for donors.
Collapse
Affiliation(s)
- Kyung Don Yoo
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yaerim Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sehoon Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Joong Shin Park
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Joon Seok Hong
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|