Assessment for kidney transplant influenced by race, insurance

By Lauretta Ihonor, MedWire Reporter

Black patients aged less than 35 years and without private insurance are less likely to receive assessment for kidney transplant on starting dialysis than other individuals, researchers report.

"This group is particularly worthy of scrutiny, because unlike older age or medical unsuitability, lack of assessment is potentially addressable," say the investigators in the Clinical Journal of the American Society of Nephrology.

Kirsten Johansen (San Francisco VA Medical Center, California, USA) and team analyzed data obtained from 426,489 US adult kidney disease patients with no history of kidney transplant.

All patients started dialysis treatment between 2005 through 2009.

The analysis revealed that 12.5% of these patients did not receive assessment for kidney transplantation prior to dialysis commencement.

When patients were grouped into five age categories: 18‑34, 35‑49, 50‑64, 65‑79, and 80 years and older, Johansen and colleagues noticed that in the 18‑34 years group, Black patients were less frequently assessed for transplantation than patients of other races.

Indeed, Black patients aged 18‑34 years were 1.43 times more likely to not receive assessment for kidney transplant than other individuals in that age group.

In other age categories, however, Black race showed a positive but weaker association with rate of nonassessment for transplant than in the 18‑34 years group.

Among the overall cohort, Black race had an odds ratio of 1.05 for no kidney transplant assessment.

Further analysis revealed that patients of all ages without private insurance were 1.33 times more likely to not be assessed than those with private insurance.

Johansen and team also found that patients not assessed for transplant before commencing dialysis were 41% less likely to be put on a kidney transplant waiting list than those who were assessed.

"The disparities that we observed primarily affected younger patients, for whom early referral may be the most important, because younger patients' life expectancy may be increased to a greater extent than older patients' life expectancy by receipt of a kidney transplant," remark the researchers.

Johansen et al conclude that their findings indicate a need for interventions that encourage healthcare providers to assess suspected kidney disease patients of all ages and races early in the disease process.

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