Concerns about kidney transplantation are very high among kidney failure patients, particularly older adults and women, but why?
There are thousands of patients with kidney failure who lack access to kidney transplantation, and disparities persist in terms of race, age, sex, and other patient characteristics. That gets a lot of attention but what gets less mention is those disparities are in large part self-created.
To improve access, it's important to understand the sources of the disparities. Are patients unaware of transplantation and clinicians don't explain it, clinicians don't give referrals, or are patient concerns causing them to avoid transplantation despite appropriate referrals?
Dorry Segev, MD, PhD, of the Johns Hopkins University School of Public Health, and colleagues conducted a study to understand the concerns and perceived barriers that dialysis patients have about pursuing transplantation, and what patient characteristics are associated with such concerns.
Among 348 adults who recently initiated dialysis and were recruited from 26 free-standing dialysis centers around Baltimore between 2009 and 2012, the most frequently cited concerns were that participants felt they were doing fine on dialysis (68.4%) and felt uncomfortable asking someone to donate a kidney (29.9%). Older age was independently associated with having high health-related or psychosocial concerns, as was being a woman, being less educated, and having more comorbid illnesses.
Patients having such concerns had less than half the chance of getting listed for a transplant than those without them. Having never seen a kidney specialist before initiating dialysis was linked with high psychosocial concerns.
"The study is an important reminder that major disparities still exist in access to kidney transplantation, and it sheds some light on the mechanism of these disparities," said Segev about the paper in the Clinical Journal of the American Society of Nephrology. Reducing these concerns may help decrease disparities in access to transplantation. "Knowing that older patients, women, and less educated individuals have more concerns about transplantation, and as a result are less likely to seek transplantation, should inspire the development of educational programs to address these concerns and help patients make the most informed treatment decisions possible."