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Pedreira-Robles G, Garcimartín P, Pérez-Sáez MJ, Bach-Pascual A, Crespo M, Morín-Fraile V. Complex management and descriptive cost analysis of kidney transplant candidates: a descriptive cross-sectional study. BMC Health Serv Res 2024; 24:763. [PMID: 38915005 PMCID: PMC11197358 DOI: 10.1186/s12913-024-11200-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/12/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND The organisational care needs involved in accessing kidney transplant have not been described in the literature and therefore a detailed analysis thereof could help to establish a framework (including appropriate timing, investment, and costs) for the management of this population. The main objective of this study is to analyse the profile and care needs of kidney transplant candidates in a tertiary hospital and the direct costs of studying them. METHODS A descriptive, cross-sectional study was conducted using data on a range of variables (sociodemographic and clinical characteristics, study duration, and investment in visits and supplementary tests) from 489 kidney transplant candidates evaluated in 2020. RESULTS The comorbidity index was high (> 4 in 64.3%), with a mean of 5.6 ± 2.4. Part of the study population had certain characteristics that could hinder their access a kidney transplant: physical dependence (9.4%), emotional distress (33.5%), non-adherent behaviours (25.2%), or language barriers (9.4%). The median study duration was 6.6[3.4;14] months. The ratio of required visits to patients was 5.97:1, meaning an investment of €237.10 per patient, and the ratio of supplementary tests to patients was 3.5:1, meaning an investment of €402.96 per patient. CONCLUSIONS The study population can be characterised as complex due to their profile and their investment in terms of time, visits, supplementary tests, and direct costs. Management based on our results involves designing work-adaptation strategies to the needs of the study population, which can lead to increased patient satisfaction, shorter waiting times, and reduced costs.
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Affiliation(s)
- Guillermo Pedreira-Robles
- Nephrology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- ESIMar (Mar Nursing School), Parc de Salut Mar, Universitat Pompeu Fabra Affiliated, Barcelona, Spain
- SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Nursing and Health PhD Programme, University of Barcelona, Barcelona, Spain
| | - Paloma Garcimartín
- Nursing department, Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25-29, Barcelona, 08003, Spain.
- Research Group in Nursing Care, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
- Biomedical Network Research Center for Cardiovascular Diseases, (CIBERCV, Carlos III Health Institute), Madrid, Spain.
| | - María José Pérez-Sáez
- Nephrology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Kidney Research Grup (GREN), Hospital del Mar Medical Research Institute (IMIM), RD16/0009/0013 (ISCIII FEDER REDinREN), Barcelona, Spain
| | - Anna Bach-Pascual
- Nephrology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Marta Crespo
- Nephrology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
- Kidney Research Grup (GREN), Hospital del Mar Medical Research Institute (IMIM), RD16/0009/0013 (ISCIII FEDER REDinREN), Barcelona, Spain
| | - Victoria Morín-Fraile
- Department of Public Health, Mental Health, and Maternal and Child Health, Faculty of Nursing, University of Barcelona, Barcelona, Spain
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2
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Malinzak L, Gartrelle K, Sragi Z, Segal A, Prashar R, Jesse MT. Access to robotic assisted kidney transplant for recipients: a systematic review and call for reporting standards. J Robot Surg 2024; 18:239. [PMID: 38833043 DOI: 10.1007/s11701-024-01927-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 03/24/2024] [Indexed: 06/06/2024]
Abstract
Robot-assisted kidney transplantation (RAKT) is a relatively novel, minimally invasive option for kidney transplantation. However, clarity on recipient selection in the published literature is lacking thereby significantly limiting interpretation of safety and other outcomes. This systematic review aimed to identify and synthesize the data on selection of RAKT recipients, compare the synthesized data to kidney transplant recipients across the USA, and explore geographical clusters of availability of RAKT. Systematic literature review, in accordance with PRISMA, via OVID MEDLINE, Embase, and Web of science from inception to March 5, 2023. All data entry double blinded and quality via Newcastle Ottawa Scale. 44 full-text articles included, encompassing approximately 2402 kidney transplant recipients at baseline but with considerable suspicion for overlap across publications. There were significant omissions of information across studies on patient selection for RAKT and/or analysis. Overall, the quality of studies was very low. Given suspicion of overlap across studies, it is difficult to determine how many RAKT recipients received living (LD) versus deceased donor (DD) organs, but a rough estimate suggests 89% received LD. While the current RAKT literature provides preliminary evidence on safety, there are significant omissions in reporting on patient selection for RAKT which limits interpretation of findings. Two recommendations: (1) international consensus is needed for reporting guidelines when publishing RAKT data and (2) larger controlled trials consistently reporting recipient characteristics are needed to clearly determine selection, safety, and outcomes across both LD and DD recipients.
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Affiliation(s)
- Lauren Malinzak
- Henry Ford Health, Transplant Institute, 2799 West Grand Boulevard, Clara Ford Pavilion, Detroit, MI, 48202, USA.
| | - Kendyll Gartrelle
- Henry Ford Health, Transplant Institute, 2799 West Grand Boulevard, Clara Ford Pavilion, Detroit, MI, 48202, USA
| | - Zara Sragi
- Henry Ford Health, Transplant Institute, 2799 West Grand Boulevard, Clara Ford Pavilion, Detroit, MI, 48202, USA
| | - Antu Segal
- Henry Ford Health, Transplant Institute, 2799 West Grand Boulevard, Clara Ford Pavilion, Detroit, MI, 48202, USA
| | - Rohini Prashar
- Henry Ford Health, Transplant Institute, 2799 West Grand Boulevard, Clara Ford Pavilion, Detroit, MI, 48202, USA
| | - Michelle T Jesse
- Henry Ford Health, Transplant Institute, 2799 West Grand Boulevard, Clara Ford Pavilion, Detroit, MI, 48202, USA
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3
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Adoli L, Raffray M, Châtelet V, Vigneau C, Lobbedez T, Gao F, Bayer F, Campéon A, Vabret E, Laude L, Jais JP, Daugas E, Couchoud C, Bayat S. Women's Access to Kidney Transplantation in France: A Mixed Methods Research Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13524. [PMID: 36294104 PMCID: PMC9603645 DOI: 10.3390/ijerph192013524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
Kidney transplantation is the best renal replacement therapy (medically and economically) for eligible patients with end-stage kidney disease. Studies in some French regions and in other countries suggest a lower access to the kidney transplant waiting listing and also to kidney transplantation, once waitlisted, for women. Using a mixed methods approach, this study aims to precisely understand these potential sex disparities and their causes. The quantitative study will explore the geographic disparities, compare the determinants of access to the waiting list and to kidney transplantation, and compare the reasons and duration of inactive status on the waiting list in women and men at different scales (national, regional, departmental, and census-block). The qualitative study will allow describing and comparing women's and men's views about their disease and transplantation, as well as nephrologists' practices relative to the French national guidelines on waiting list registration. This type of study is important in the current societal context in which the reduction of sex/gender-based inequalities is a major social expectation.
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Affiliation(s)
- Latame Adoli
- Université de Rennes, EHESP, CNRS, INSERM, Arènes–UMR 6051, RSMS–U1309, 35000 Rennes, France
| | - Maxime Raffray
- Université de Rennes, EHESP, CNRS, INSERM, Arènes–UMR 6051, RSMS–U1309, 35000 Rennes, France
| | - Valérie Châtelet
- U1086 INSERM, Anticipe, Centre de Lutte Contre le Cancer François Baclesse, Centre Universitaire des Maladies Rénales, 14000 Caen, France
| | - Cécile Vigneau
- IRSET (Institut de Recherche en Santé, Environnement et Travail), Université de Rennes, Chu Rennes, INSERM, EHESP, UMR_s 1085, 35000 Rennes, France
| | - Thierry Lobbedez
- U1086 INSERM, Anticipe, Centre de Lutte Contre le Cancer François Baclesse, Centre Universitaire des Maladies Rénales, 14000 Caen, France
| | - Fei Gao
- Université de Rennes, EHESP, CNRS, INSERM, Arènes–UMR 6051, RSMS–U1309, 35000 Rennes, France
| | - Florian Bayer
- Renal Epidemiology and Information Network (Rein) Registry, Biomedecine Agency, Saint-Denis-la-Plaine, 93212 Paris, France
| | - Arnaud Campéon
- Arènes–UMR 6051, ISSAV, EHESP, CNRS, 35000 Rennes, France
| | - Elsa Vabret
- Service de Néphrologie, Chu Rennes, 35000 Rennes, France
| | - Laëtitia Laude
- Université de Rennes, EHESP, CNRS, INSERM, Arènes–UMR 6051, RSMS–U1309, 35000 Rennes, France
| | - Jean-Philippe Jais
- Unité de Biostatistique, Hôpital Necker-Enfants Malades, AP-HP, Institut Imagine, Université Paris-Cité, 75015 Paris, France
| | - Eric Daugas
- INSERM U1149, Université Paris Cité, Assistance Publique-Hôpitaux de Paris, Service de Néphrologie, Hôpital Bichat, 75018 Paris, France
| | - Cécile Couchoud
- Renal Epidemiology and Information Network (Rein) Registry, Biomedecine Agency, Saint-Denis-la-Plaine, 93212 Paris, France
| | - Sahar Bayat
- Université de Rennes, EHESP, CNRS, INSERM, Arènes–UMR 6051, RSMS–U1309, 35000 Rennes, France
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4
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Schappe T, Peskoe S, Bhavsar N, Boulware LE, Pendergast J, McElroy LM. Geospatial Analysis of Organ Transplant Referral Regions. JAMA Netw Open 2022; 5:e2231863. [PMID: 36107423 PMCID: PMC9478781 DOI: 10.1001/jamanetworkopen.2022.31863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
IMPORTANCE System and center-level interventions to improve health equity in organ transplantation benefit from robust characterization of the referral population served by each transplant center. Transplant referral regions (TRRs) define geographic catchment areas for transplant centers in the US, but accurately characterizing the demographics of populations within TRRs using US Census data poses a challenge. OBJECTIVE To compare 2 methods of linking US Census data with TRRs-a geospatial intersection method and a zip code cross-reference method. DESIGN, SETTING, AND PARTICIPANTS This cohort study compared spatial congruence of spatial intersection and zip code cross-reference methods of characterizing TRRs at the census block level. Data included adults aged 18 years and older on the waiting list for kidney transplant from 2008 through 2018. EXPOSURES End-stage kidney disease. MAIN OUTCOMES AND MEASURES Multiple assignments, where a census tract or block group crossed the boundary between 2 hospital referral regions and was assigned to multiple different TRRs; misassigned area, the portion of census tracts or block groups assigned to a TRR using either method but fall outside of the TRR boundary. RESULTS In total, 102 TRRs were defined for 238 transplant centers. The zip code cross-reference method resulted in 4627 multiple-assigned census block groups (representing 18% of US land area assigned to TRRs), while the spatial intersection method eliminated this problem. Furthermore, the spatial method resulted in a mean and median reduction in misassigned area of 65% and 83% across all TRRs, respectively, compared with the zip code cross-reference method. CONCLUSIONS AND RELEVANCE In this study, characterizing populations within TRRs with census block groups provided high spatial resolution, complete coverage of the country, and balanced population counts. A spatial intersection approach avoided errors due to duplicative and incorrect assignments, and allowed more detailed and accurate characterization of the sociodemographics of populations within TRRs; this approach can enrich transplant center knowledge of local referral populations, assist researchers in understanding how social determinants of health may factor into access to transplant, and inform interventions to improve heath equity.
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Affiliation(s)
- Tyler Schappe
- Duke University, School of Medicine, Durham, North Carolina
| | - Sarah Peskoe
- Duke University, School of Medicine, Durham, North Carolina
| | - Nrupen Bhavsar
- Duke University, School of Medicine, Durham, North Carolina
| | | | | | - Lisa M McElroy
- Duke University, School of Medicine, Durham, North Carolina
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5
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Birkefeld K, Bauer-Hohmann M, Klewitz F, Kyaw Tha Tun EM, Tegtbur U, Pape L, Schiffer L, Schiffer M, de Zwaan M, Nöhre M. Prevalence of Mental Disorders in a German Kidney Transplant Population: Results of a KTx360°-Substudy. J Clin Psychol Med Settings 2022; 29:963-976. [PMID: 35195827 DOI: 10.1007/s10880-022-09861-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 11/26/2022]
Abstract
In patients after kidney transplantation (KTx) an increased rate of affective and anxiety disorders has been observed. Repeatedly, a relationship between mental health issues and increased morbidity and mortality in KTx recipients has been reported. However, information on the prevalence of mental disorders in KTx patients is scarce. As part of the structured multimodal follow-up program (KTx360°), mental disorders were examined in 726 patients after KTx through structured diagnostic interviews using the Mini-DIPS Open Access. Overall, 27.5% had a current and 49.2% a lifetime mental disorder. Only 14.5% with a current mental disorder reported to be in treatment. Affected patients were younger, more often female, reported more symptoms of anxiety and depression and less perceived social support. While comparable to the rate in general population samples, the prevalence of mental disorders should attract attention. The low treatment rate requires an improved identification of afflicted patients and provision of specialist treatment.ISRCTN registry, https://doi.org/10.1186/ISRCTN29416382 , date of registry: 03.05.2017.
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Affiliation(s)
- Katrin Birkefeld
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany
- Institute of Legal Medicine and Forensic Sciences, Charité-Universiätsmedizin, Berlin, Germany
| | - Maximilian Bauer-Hohmann
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany
| | - Felix Klewitz
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany
| | - Eva-Marie Kyaw Tha Tun
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
| | - Uwe Tegtbur
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany
- Department of Sports Medicine, Hannover Medical School, Hannover, Germany
| | - Lars Pape
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
- Department of Pediatrics II, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Lena Schiffer
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Mario Schiffer
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany
| | - Mariel Nöhre
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany.
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6
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Mojapelo MR, Maboe KA. Knowledge, attitude and barriers to kidney donation in Limpopo province, South Africa. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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7
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Pecoits-Filho R, Okpechi IG, Donner JA, Harris DC, Aljubori HM, Bello AK, Bellorin-Font E, Caskey FJ, Collins A, Cueto-Manzano AM, Feehally J, Goh BL, Jager KJ, Nangaku M, Rahman M, Sahay M, Saleh A, Sola L, Turan Kazancioglu R, Walker RC, Walker R, Yao Q, Yu X, Zhao MH, Johnson DW. Capturing and monitoring global differences in untreated and treated end-stage kidney disease, kidney replacement therapy modality, and outcomes. Kidney Int Suppl (2011) 2020; 10:e3-e9. [PMID: 32149004 PMCID: PMC7031690 DOI: 10.1016/j.kisu.2019.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/11/2019] [Accepted: 11/07/2019] [Indexed: 12/17/2022] Open
Abstract
A large gap between the number of people with end-stage kidney disease (ESKD) who received kidney replacement therapy (KRT) and those who needed it has been recently identified, and it is estimated that approximately one-half to three-quarters of all people with ESKD in the world may have died prematurely because they could not receive KRT. This estimate is aligned with a previous report that estimated that >3 million people in the world died each year because they could not access KRT. This review discusses the reasons for the differences in treated and untreated ESKD and KRT modalities and outcomes and presents strategies to close the global KRT gap by establishing robust health information systems to guide resource allocation to areas of need, inform KRT service planning, enable policy development, and monitor KRT health outcomes.
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Affiliation(s)
- Roberto Pecoits-Filho
- School of Medicine, Pontificia Universidade Catolica do Paraná, Curitiba, Brazil
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Ikechi G. Okpechi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Jo-Ann Donner
- International Society of Nephrology, Brussels, Belgium
| | - David C.H. Harris
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Harith M. Aljubori
- Nephrology Department, Alqassimi Hospital, Sharjah, United Arab Emirates
| | - Aminu K. Bello
- Division of Nephrology and Immunity, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ezequiel Bellorin-Font
- Division of Nephology and Hypertension, Department of Medicine, Saint Louis University, Saint Louis, Missouri, USA
| | - Fergus J. Caskey
- UK Renal Registry, Learning and Research, Southmead Hospital, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol, UK
- The Richard Bright Renal Unit, Southmead Hospital, North Bristol National Health Service Trust, Bristol, UK
| | - Allan Collins
- NxStage Medical, Inc., Lawrence, Massachusetts, USA
- Department of Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Alfonso M. Cueto-Manzano
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
| | | | - Bak Leong Goh
- Department of Nephrology and Clinical Research Centre, Hospital Serdang, Jalan Puchong, Kajang, Selangor, Malaysia
| | - Kitty J. Jager
- European Renal Association–European Dialysis and Transplant Association (ERA-EDTA) Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Masaomi Nangaku
- Division of Nephrology, The University of Tokyo School of Medicine, Hongo, Japan
| | - Muhibur Rahman
- Department of Nephrology, Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh
| | - Manisha Sahay
- Department of Nephrology, Osmania Medical College and General Hospital, Hyderabad, Telangana, India
| | - Abdulkarim Saleh
- Department of Nephrology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Laura Sola
- Dialysis Unit, Centro Asistencial del Sindicato Médico del Uruguay Institución de Asistencia Médica Privada de Profesionales Sin Fines de lucro, Montevideo, Uruguay
| | - Rumeyza Turan Kazancioglu
- Division of Nephrology, Bezmialem Vakif University, Istanbul, Turkey
- Walker, School of Nursing, Eastern Institute of Technology, Napier, New Zealand
| | - Rachael C. Walker
- Division of Nephrology, Bezmialem Vakif University, Istanbul, Turkey
- Walker, School of Nursing, Eastern Institute of Technology, Napier, New Zealand
- Renal Department, Hawke's Bay District Health Board, Hastings, New Zealand
| | - Robert Walker
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Qiang Yao
- Medical Affairs, Baxter Healthcare, Guangzhou, China
| | - Xueqing Yu
- Division of Nephrology, Guangdong Provincial People’s School of Medicine, South China University of Technology, Guangzhou, China
- Key Laboratory of Nephrology, Ministry of Health, Guangzhou, Guangdong, China
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China, Beijing, China
- Peking-Tsinghua Center for Life Sciences, Beijing, China
| | - David W. Johnson
- Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
- Metro South and Ipswich Nephrology and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
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8
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Li L, Bokshan SL, Mehta SR, Owens BD. Disparities in Cost and Access by Caseload for Arthroscopic Rotator Cuff Repair: An Analysis of 18,616 Cases. Orthop J Sports Med 2019; 7:2325967119850503. [PMID: 31218237 PMCID: PMC6558544 DOI: 10.1177/2325967119850503] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Surgeon caseload has been shown to affect both health and economic outcomes in arthroscopic rotator cuff repair. Although previous studies have investigated disparities in access to care, little is known about disparities between low- and high-volume surgeons and facilities. Purpose To identify where disparities may exist regarding access to high-volume surgeons and facilities. Study Design Cross-sectional study. Methods Univariate analysis was performed to analyze differences in the caseload between low- and high-volume surgeons and facilities. Cutoff values were set at 50 cases per year for high-volume surgeons and 125 cases annually for high-volume facilities. Multiple linear regression was then used to develop a cost model incorporating all variables significant under univariate analysis. We collected 18,616 cases with Current Procedural Terminology code 29827 ("arthroscopic rotator cuff repair") from the 2014 Florida State Ambulatory Surgery and Services Databases. Results A greater proportion of the caseload for low-volume surgeons and facilities was composed of patients who were of lower socioeconomic status, had government-subsidized insurance, or lived in areas with low-income ZIP codes. Low-volume surgeons and facilities also had higher total charges, higher postoperative admission rates, and lower distal clavicle excision rates (P < .001). In our cost model, a low facility volume significantly increased costs. Subacromial decompression, postoperative admission, distal clavicle excision, male sex, and government-subsidized insurance were all significant factors for increased costs in multivariate cost analysis. Conclusion There are disparities in access to high-volume surgeons and facilities for patients undergoing arthroscopic rotator cuff repair in Florida. Patients with a lower socioeconomic status, government-subsidized insurance, and low income all faced decreased access to these high-volume groups. High-volume surgeons and facilities were associated with lower total charges, higher rates of distal clavicle excision, and lower readmission rates. Low-volume facilities added a significant amount of cost, even when controlling for all other significant variables. It is important for providers to be aware of these disparities and work to address them in their own practices.
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Affiliation(s)
- Lambert Li
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Steven L Bokshan
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Shayna R Mehta
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Brett D Owens
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
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9
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Holscher CM, Locham SS, Haugen CE, Bae S, Segev DL, Malas MB. Transplant waitlisting attenuates the association between hemodialysis access type and mortality. J Nephrol 2019; 32:477-485. [PMID: 30604152 PMCID: PMC6483887 DOI: 10.1007/s40620-018-00572-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/17/2018] [Indexed: 11/24/2022]
Abstract
Prior studies have shown that beginning hemodialysis (HD) with a hemodialysis catheter (HC) is associated with worse mortality than with an arteriovenous fistula (AVF) or arteriovenous graft (AVG). We hypothesized that transplant waitlisting would modify the effect of HD access on mortality, given waitlist candidates' more robust health status. Using the US Renal Data System, we studied patients with incident ESRD who initiated HD between 2010 and 2015 with an AVF, AVG, or HC. We used Cox regression including an interaction term for HD access and waitlist status. There were 587,607 patients that initiated HD, of whom 82,379 (14.0%) were waitlisted for transplantation. Only 26,264 (4.5%) were transplanted. Among patients not listed, those with an AVF had a 34% lower mortality compared to HC [adjusted hazard ratio (aHR) 0.66, 95% confidence interval (CI) 0.65-0.67] while those with an AVG had a 21% lower mortality compared to HC (aHR 0.79, 95% CI 0.77-0.81). Transplant waitlisting attenuated the association between hemodialysis access type and mortality (interaction p < 0.001 for both AVF and AVG vs. HC). Among patients on the waitlist, those with an AVF had a 12% lower mortality compared to HC (aHR 0.88, 95% CI 0.84-0.93), while those with an AVG had no difference in mortality (aHR 0.95, 95% CI 0.84-1.08). While all patients benefit from AVF or AVG over HC, the benefit was attenuated in waitlisted patients. Efforts to improve health status and access to healthcare for non-waitlisted ESRD patients might decrease HD-associated mortality and improve rates of AVF and AVG placement.
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Affiliation(s)
| | | | | | - Sunjae Bae
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dorry L Segev
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mahmoud B Malas
- University of California San Diego, San Diego, CA, USA.
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Ke C, Kim SJ, Shah BR, Bierman AS, Lipscombe LL, Feig DS, Booth GL. Impact of Socioeconomic Status on Incidence of End-Stage Renal Disease and Mortality After Dialysis in Adults With Diabetes. Can J Diabetes 2019; 43:483-489.e4. [PMID: 31133437 DOI: 10.1016/j.jcjd.2019.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/13/2019] [Accepted: 04/12/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To determine whether low socioeconomic status (SES), with or without universal drug coverage, predicts end-stage renal disease (ESRD) and survival after dialysis in patients with diabetes. METHODS We conducted a population-based retrospective cohort study in Ontario, Canada. We used ≥65 years of age as a surrogate for universal drug coverage. Adults with diabetes were followed from March 31, 1997 to March 31, 2011 for occurrence of the composite primary outcome (acute kidney injury, ESRD requiring dialysis or kidney transplantation). Patients on dialysis with diabetes were followed from April 1, 1994 to March 31, 2011 for occurrence of death or transplantation. RESULTS SES quintile (Q) was inversely associated with the primary outcome in both age groups; however, the gradient was higher in those <65 years of age (Q1:Q5 hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.37-1.49) compared with ≥65 years of age (HR, 1.19; 95% CI, 1.15-1.24). Low SES was associated with a lower likelihood of kidney transplantation among those <65 years of age (HR, 0.77; 95% CI, 0.65-0.92). In patients on dialysis, low SES was associated with higher mortality (HR, 1.09; 95% CI, 1.02-1.16) in both age groups. This association was eliminated after accounting for the decreased rates of kidney transplantation in lower SES groups. CONCLUSIONS SES is inversely associated with ESRD outcomes in individuals with diabetes, and this disparity is reduced in those ≥65 years of age who universally receive prescription drug coverage. Low SES is associated with a higher mortality after dialysis, largely explained by lower kidney transplantation rates in poorer populations.
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Affiliation(s)
- Calvin Ke
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - S Joseph Kim
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R Shah
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Arlene S Bierman
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland, United States
| | | | - Denice S Feig
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gillian L Booth
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Odegard M, Serrano OK, Peterson K, Mongin SJ, Berglund D, Vock DM, Chinnakotla S, Dunn TB, Finger EB, Kandaswamy R, Pruett TL, Matas AJ. Delivery of transplant care among Hmong kidney transplant recipients: Outcomes from a single institution. Clin Transplant 2019; 33:e13539. [DOI: 10.1111/ctr.13539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 02/26/2019] [Accepted: 03/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Marjorie Odegard
- Division of Transplantation Department of Surgery Minneapolis Minnesota
| | - Oscar K. Serrano
- Division of Transplantation Department of Surgery Minneapolis Minnesota
| | - Kent Peterson
- Division of Transplantation Department of Surgery Minneapolis Minnesota
| | - Steven J. Mongin
- Biostatistical Design and Analysis Center Clinical and Translational Science Institute Minneapolis Minnesota
| | - Danielle Berglund
- Informatics Services for Research and Reporting, Fairview Minneapolis Minnesota
| | - David M. Vock
- Division of Biostatistics, School of Public Health University of Minnesota Minneapolis Minnesota
| | | | - Ty B. Dunn
- Division of Transplantation Department of Surgery Minneapolis Minnesota
| | - Erik B. Finger
- Division of Transplantation Department of Surgery Minneapolis Minnesota
| | - Raja Kandaswamy
- Division of Transplantation Department of Surgery Minneapolis Minnesota
| | - Timothy L. Pruett
- Division of Transplantation Department of Surgery Minneapolis Minnesota
| | - Arthur J. Matas
- Division of Transplantation Department of Surgery Minneapolis Minnesota
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Frech A, Natale G, Tumin D. Couples' employment after spousal kidney donation. SOCIAL WORK IN HEALTH CARE 2018; 57:880-889. [PMID: 30300111 DOI: 10.1080/00981389.2018.1523823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We used data from the United Network for Organ Sharing registry of living kidney donors and recipients to identify correlates of paid employment among couples following spousal living donation. Among such couples, post-transplant employment of both spouses (41%) was as common as employment of the donor only (41%). However, when the recipient was female, donor-only employment after transplant was more than twice as likely as compared to employment of both spouses (relative risk ratio = 2.57; p < .001). We conclude that traditional gender roles regarding paid workforce participation may be associated with the likelihood of employment after spousal kidney donation.
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Affiliation(s)
- Adrianne Frech
- a Department of Health Sciences , University of Missouri , Columbia , Missouri , USA
| | - Ginny Natale
- b Department of Sociology , Kent State University , Kent , Ohio , USA
| | - Dmitry Tumin
- c Department of Pediatrics , The Ohio State University College of Medicine , Columbus , Ohio , USA
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14
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Châtelet V, Bayat-Makoei S, Vigneau C, Launoy G, Lobbedez T. Renal transplantation outcome and social deprivation in the French healthcare system: a cohort study using the European Deprivation Index. Transpl Int 2018; 31:1089-1098. [DOI: 10.1111/tri.13161] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 01/15/2018] [Accepted: 03/22/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Valérie Châtelet
- Centre Universitaire des Maladies Rénales; CHU de Caen; Caen Cedex 9 France
| | | | | | - Guy Launoy
- Centre de Lutte Contre le Cancer François Baclesse; U1086 Inserm, ‘ANTICIPE’; Caen Cedex 05 France
| | - Thierry Lobbedez
- Centre Universitaire des Maladies Rénales; CHU de Caen; Caen Cedex 9 France
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15
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Tacrolimus Trough Concentration Variability and Disparities in African American Kidney Transplantation. Transplantation 2017; 101:2931-2938. [PMID: 28658199 DOI: 10.1097/tp.0000000000001840] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Low tacrolimus concentrations have been associated with higher risk of acute rejection, particularly within African American (AA) kidney transplant recipients; little is known about intrapatient tacrolimus variabilities impact on racial disparities. METHODS Ten year, single-center, longitudinal cohort study of kidney recipients. Intrapatient tacrolimus variability was assessed using the coefficient of variation (CV) measured between 1 month posttransplant and the clinical event, with a comparable period assessed in those without events. Pediatrics, nontacrolimus/mycophenolate regimens, and nonrenal transplants were excluded. Multivariable Cox regression models were used to analyze data. RESULTS One thousand four hundred eleven recipients were included (54.4% AA) with 39 521 concentrations used to assess intrapatient tacrolimus CV. Overall, intrapatient tacrolimus CV was higher in AAs versus non-AAs (39.9 ± 19.8 % vs 34.8 ± 15.8% P < 0.001). Tacrolimus variability was a significant risk factor for deleterious clinical outcomes. A 10% increase in tacrolimus CV augmented the risk of acute rejection by 20% (adjusted hazard ratio, 1.20, 1.13-1.28; P < 0.001) and the risk of graft loss by 30% (adjusted hazard ratio, 1.30, 1.23-1.37; P < 0.001), with significant effect modification by race for acute rejection, but not graft loss. High tacrolimus variability (CV >40%) was a significant explanatory variable for disparities in AAs; the crude relative risk of acute rejection in AAs was reduced by 46% when including tacrolimus variability in modeling and reduced by 40% for graft loss. CONCLUSIONS These data demonstrate that intrapatient tacrolimus variability is strongly associated with acute rejection in AAs and graft loss in all patients. Tacrolimus variability is a significant explanatory variable for disparities in AA recipients.
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16
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Châtelet V, Lobbedez T, Harambat J, Bayat-Makoei S, Glowacki F, Vigneau C. [Socioeconomic inequalities and kidney transplantation]. Nephrol Ther 2017; 14:81-84. [PMID: 29198520 DOI: 10.1016/j.nephro.2017.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 04/04/2017] [Indexed: 11/27/2022]
Abstract
Studies at the population level must take into account the effect of social insecurity and socioeconomic inequalities on the patient outcomes. Socioeconomic inequalities depend on many determinants that are socially determined. In renal transplantation, these social determinants are not registered in the databases. The European Deprivation Index (EDI) is a composite index of social vulnerability with a French version. The EDI is an ecological measure of deprivation including the individual perception of basic needs for daily life that is called "subjective poverty". The Townsend index, Carstairs index and the Index of Multiple Deprivation are other ecological index available. It has been demonstrated in the United States that socioeconomic indicators of deprivation were associated with both the access to the waiting list for renal transplantation and transplantation failure. In France, socioeconomic deprivation may also affect the access to the waiting list and outcome of transplantation. This article is a review about deprivation and renal transplantation.
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Affiliation(s)
- Valérie Châtelet
- Centre universitaire des maladies rénales, CHU de Caen, avenue Côte-de-Nacre, CS 30001, 14033 Caen cedex 9, France.
| | - Thierry Lobbedez
- Centre universitaire des maladies rénales, CHU de Caen, avenue Côte-de-Nacre, CS 30001, 14033 Caen cedex 9, France
| | - Jérôme Harambat
- Service de pédiatrie, néphrologie pédiatrique, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Sahar Bayat-Makoei
- EHESP Rennes, Sorbonne Paris cité, EA 7449 Repères, 15, avenue du Professeur-Léon-Bernard, CS 74312, 35043 Rennes, France
| | - François Glowacki
- Service de néphrologie, hôpital Huriez, CHRU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - Cécile Vigneau
- Service de néphrologie, CHU Pontchaillou, 2, rue Henri-le-Guilloux, 35000 Rennes, France
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Taber DJ, Hamedi M, Rodrigue JR, Gebregziabher MG, Srinivas TR, Baliga PK, Egede LE. Quantifying the Race Stratified Impact of Socioeconomics on Graft Outcomes in Kidney Transplant Recipients. Transplantation 2017; 100:1550-7. [PMID: 26425875 DOI: 10.1097/tp.0000000000000931] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Socioeconomic status (SES) is a significant determinant of health outcomes and may be an important component of the causal chain surrounding racial disparities in kidney transplantation. The social adaptability index (SAI) is a validated and quantifiable measure of SES, with a lack of studies analyzing this measure longitudinally or between races. METHODS Longitudinal cohort study in adult kidney transplantation transplanted at a single-center between 2005 and 2012. The SAI score includes 5 domains (employment, education, marital status, substance abuse and income), each with a minimum of 0 and maximum of 3 for an aggregate of 0 to 15 (higher score → better SES). RESULTS One thousand one hundred seventy-one patients were included; 624 (53%) were African American (AA) and 547 were non-AA. African Americans had significantly lower mean baseline SAI scores (AAs 6.5 vs non-AAs 7.8; P < 0.001). Cox regression analysis demonstrated that there was no association between baseline SAI and acute rejection in non-AAs (hazard ratio [HR], 0.92; 95% confidence interval [95% CI], 0.81-1.05), whereas it was a significant predictor of acute rejection in AAs (HR, 0.89; 95% CI, 0.80-0.99). Similarly, a 2-stage approach to joint modelling of time to graft loss and longitudinal SAI did not predict graft loss in non-AAs (HR, 1.01; 95% CI, 0.28-3.62), whereas it was a significant predictor of graft loss in AAs (HR, 0.23; 95% CI, 0.06-0.93). CONCLUSIONS After controlling for confounders, SAI scores were associated with a lower risk of acute rejection and graft loss in AA kidney transplant recipients, whereas neither baseline nor follow-up SAI predicted outcomes in non-AA kidney transplant recipients.
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Affiliation(s)
- David J Taber
- 1 Division of Transplant Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC. 2 Department of Pharmacy, Ralph H Johnson VAMC, Charleston, SC. 3 College of Medicine, Medical University of South Carolina, Charleston, SC. 4 Transplant Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. 5 Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC. 6 Division of Transplant Nephrology, College of Medicine, Medical University of South Carolina, Charleston, SC. 7 Veterans Affairs HSR&D Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H Johnson VAMC, Charleston, SC
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Overall Graft Loss Versus Death-Censored Graft Loss: Unmasking the Magnitude of Racial Disparities in Outcomes Among US Kidney Transplant Recipients. Transplantation 2017; 101:402-410. [PMID: 26901080 DOI: 10.1097/tp.0000000000001119] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Black kidney transplant recipients experience disproportionately high rates of graft loss. This disparity has persisted for 40 years, and improvements may be impeded based on the current public reporting of overall graft loss by US regulatory organizations for transplantation. METHODS Longitudinal cohort study of kidney transplant recipients using a data set created by linking Veterans Affairs and US Renal Data System information, including 4918 veterans transplanted between January 2001 and December 2007, with follow-up through December 2010. Multivariable analysis was conducted using 2-stage joint modeling of random and fixed effects of longitudinal data (linear mixed model) with time to event outcomes (Cox regression). RESULTS Three thousand three hundred six non-Hispanic whites (67%) were compared with 1612 non-Hispanic black (33%) recipients with 6.0 ± 2.2 years of follow-up. In the unadjusted analysis, black recipients were significantly more likely to have overall graft loss (hazard ratio [HR], 1.19; 95% confidence interval [95% CI], 1.07-1.33), death-censored graft loss (HR, 1.67; 95% CI, 1.45-1.92), and lower mortality (HR, 0.83; 95% CI, 0.72-0.96). In fully adjusted models, only death-censored graft loss remained significant (HR, 1.38; 95% CI, 1.12-1.71; overall graft loss [HR, 1.08; 95% CI, 0.91-1.28]; mortality [HR, 0.84; 95% CI, 0.67-1.06]). A composite definition of graft loss reduced the magnitude of disparities in blacks by 22%. CONCLUSIONS Non-Hispanic black kidney transplant recipients experience a substantial disparity in graft loss, but not mortality. This study of US data provides evidence to suggest that researchers should focus on using death-censored graft loss as the primary outcome of interest to facilitate a better understanding of racial disparities in kidney transplantation.
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19
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Relationships Between Illness Perceptions, Coping and Psychological Morbidity in Kidney Transplants Patients. Am J Med Sci 2016; 351:233-8. [DOI: 10.1016/j.amjms.2015.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/22/2015] [Indexed: 11/18/2022]
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