Original Investigation
Transplantation
A Randomized Trial of a Home-Based Educational Approach to Increase Live Donor Kidney Transplantation: Effects in Blacks and Whites

https://doi.org/10.1053/j.ajkd.2007.11.027Get rights and content

Background

Blacks are disproportionately affected by chronic kidney disease, but are far less likely to undergo live donor kidney transplantation (LDKT) than whites. We assessed the differential effectiveness in blacks and whites of a home-based (HB) LDKT educational approach.

Study Design

A planned secondary analysis of a previously published randomized trial.

Setting & Participants

132 patients (60 black, 72 white) approved for kidney transplantation at 1 kidney transplant center in the southeastern United States.

Intervention

Assignment to receive either standard clinic-based (CB) transplant education (n = 69) or CB plus an HB (CB + HB) LDKT education program (n = 63). The HB education program was culturally sensitive for blacks, including using a minority health educator, brochures that highlight minority transplant recipients and donors, and discussion of race-specific outcome data.

Outcomes

Primary outcomes were proportions of patients with live donor inquiries, evaluations, and transplants 1 year after study participation.

Measurements

Medical record and questionnaire data.

Results

69 patients were assigned to the CB group, and 63 to the CB + HB group. After 1 year, there were 96 living donor inquiries (72.7%), 62 living donor evaluations (47.0%), and 54 LDKTs (40.9%). Patients assigned to the CB + HB group were more likely to have had living donor inquiries (odds ratio [OR], 1.7; confidence interval [CI], 1.2 to 3.0), a living donor evaluated (OR, 2.7; CI, 1.4 to 5.4), and LDKT (OR, 3.0; CI, 1.5 to 5.9). The effect was greater in blacks than whites for living donor evaluations and LDKT, but not for living donor inquiries (treatment-by-race interaction, P < 0.001, P < 0.001, and P = 0.8, respectively). Blacks in the CB + HB group were more likely to have had at least 1 living donor inquiry (51.7% versus 77.4%), at least 1 living donor evaluated (17.2% versus 48.4%), and LDKT (13.8% versus 45.2%) than those in the CB group. By comparison, whites in the CB + HB group were more likely to have had at least 1 living donor inquiry (72.5% versus 87.5%), at least 1 living donor evaluated (47.5% versus 71.9%), and LDKT (42.5% versus 59.4%) than those in the CB group.

Limitations

Single-center study with greater dropout rate in the CB + HB group.

Conclusions

These results suggest that a culturally sensitive LDKT education program that reaches out to blacks and their social support network can overcome some barriers to LDKT in this population.

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)

  • R.P. Hertz et al.

    Racial disparities in hypertension prevalence, awareness, and management

    Arch Intern Med

    (2005)
  • F.L. Brancati et al.

    Incident type 2 diabetes mellitus in African American and white adults: The Atherosclerosis Risk in Communities Study

    JAMA

    (2000)
  • K.S. Kinchen et al.

    The timing of specialist evaluation in chronic kidney disease and mortality

    Ann Intern Med

    (2002)
  • H.U. Meier-Kriesche et al.

    Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: A paired donor kidney analysis

    Transplantation

    (2002)
  • S.P. McDonald et al.

    Survival of recipients of cadaveric kidney transplants compared with those receiving dialysis treatment in Australia and New Zealand, 1991-2001

    Nephrol Dial Transplant

    (2002)
  • C.G. Rabbat et al.

    Comparison of mortality risk for dialysis patients and cadaveric first renal transplant recipients in Ontario, Canada

    J Am Soc Nephrol

    (2000)
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    Originally published online as doi:10.1053/j.ajkd.2007.11.027 on February 19, 2008.

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