Original InvestigationTransplantationA Randomized Trial of a Home-Based Educational Approach to Increase Live Donor Kidney Transplantation: Effects in Blacks and Whites
Section snippets
Study Sample and Recruitment
Adult patients listed for kidney transplantation at Shands Hospital at the University of Florida were recruited for participation by approaching them in the waiting room immediately before a scheduled transplant clinic visit. Inclusion criteria were written informed consent, medical approval for transplantation, black or white race, at least 21 years old, primary residence within 90 miles of the transplantation center, and telephone service. Patients who were illiterate or non–English speaking
Patients
Of the 216 patients who met study eligibility criteria and were invited to participate in the study, 169 (78.2%) consented and subsequently were randomly assigned (Fig 1). Thirty-seven patients (21.9%) withdrew from the study after randomization, with greater dropout rates in the CB + HB group (n = 29) than in the CB group (n = 8; χ = 10.9; P < 0.001). Dropout rates were also greater for blacks (n = 24) than whites (n = 13; χ2 = 4.4; P = 0.03). The a priori secondary analyses that we report
Discussion
Blacks are more likely to have chronic disease states that benefit from LDKT, but are far less likely to undergo this procedure relative to whites. The consequences of this disparity are clinically significant, with longer waiting times and greater mortality on the kidney transplant waiting list for blacks. A number of reasons for this racial disparity in LDKT were posited, including a smaller pool of potential living donors (ie, because of greater rates of hypertension, obesity, and diabetes
Acknowledgements
We thank the following individuals for their assistance in the preparation and/or conduct of this study: Glenn Ashkanazi, Daniel Baughn, Jason Burns, Sandra Demasters-Reynolds, Steven Durham, Shawna Ehlers, Gary Geffken, Kathleen Giery, Robert Guenther, Jonathan Lin, Joni Lloyd-Turner, Kathleen MacNaughton, Shelly Morgan, Jeanne Renderer, Jeff Stoll, Stephanie Toy, Jennifer Watson, and Michelle Widows. We also thank the entire transplantation center staff for assistance in recruiting
References (33)
Ethnicity and renal disease
Kidney Int
(2005)- et al.
Economic analysis of kidney transplantation
Surg Clin North Am
(1998) - et al.
A study of the quality of life and cost-utility of renal transplantation
Kidney Int
(1996) - et al.
Why hemodialysis patients fail to complete the transplantation process
Am J Kidney Dis
(2001) - et al.
Increasing live donor kidney transplantation: A randomized evaluation of a home-based educational intervention
Am J Transplant
(2007) Patients’ decisions for treatment of end-stage renal disease and their implications for access to transplantation
Soc Sci Med
(2001)- et al.
Living renal donation in the African-American community
Transplant Proc
(1997) - et al.
Community education and empowerment key to increased minority donation rates
Transplant Proc
(1997) - et al.
Preferences, knowledge, communication and patient-physician discussion of living kidney transplantation in African American families
Am J Transplant
(2005) - et al.
Black-white differences in age trajectories of hypertension prevalence among adult women and men, 1999-2002
Ethn Dis
(2007)
Racial disparities in hypertension prevalence, awareness, and management
Arch Intern Med
Incident type 2 diabetes mellitus in African American and white adults: The Atherosclerosis Risk in Communities Study
JAMA
The timing of specialist evaluation in chronic kidney disease and mortality
Ann Intern Med
Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: A paired donor kidney analysis
Transplantation
Survival of recipients of cadaveric kidney transplants compared with those receiving dialysis treatment in Australia and New Zealand, 1991-2001
Nephrol Dial Transplant
Comparison of mortality risk for dialysis patients and cadaveric first renal transplant recipients in Ontario, Canada
J Am Soc Nephrol
Cited by (115)
Racialized and Immigrant Status and the Pursuit of Living Donor Kidney Transplant - a Canadian Cohort Study
2024, Kidney International ReportsA Transplant-Inclusive Value-Based Kidney Care Payment Model
2024, Kidney International ReportsProtocol for the AKT-MP trial: Access to Kidney Transplantation in Minority Populations
2022, Contemporary Clinical Trials CommunicationsCitation Excerpt :Our previous work showed that cultural/contextual factors and KT knowledge independently and significantly predict the rate of KT evaluation completion. Most efforts to reduce disparities in KT emphasize educating or changing the behavior of patients on dialysis who have not been referred for KT [16–29]. Although modestly successful [19,22,30,31], these approaches do not reduce the burden to the patient.
Induced demand in kidney replacement therapy
2022, Health PolicyA Roadmap for Innovation to Advance Transplant Access and Outcomes: A Position Statement From the National Kidney Foundation
2021, American Journal of Kidney DiseasesNeighborhood Segregation and Access to Live Donor Kidney Transplantation
2024, JAMA Internal Medicine
Originally published online as doi:10.1053/j.ajkd.2007.11.027 on February 19, 2008.