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Inequalities persist in early kidney transplantation despite policy changes



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A recent analysis reveals persistent differences in preventive transplantation when the patient receives a kidney transplant before dialysis begins, despite efforts to correct transplant inequalities. The findings appear in the forthcoming issue of CJASN.

Preventive transplantation is considered the best treatment option for patients with chronic kidney disease, which has progressed to renal failure, but its availability is limited by the lack of organ donors in terms of patients on the new kidney waiting list and patient failure. listed in a timely manner. The kidney matching system from deceased organ donors to waiting list candidates has been refurbished with the 2014 Kidney Allocation System (CAS) in an attempt to correct some transplant inequalities. To assess the effect of KAS on preventive transplantation, a team led by Sumit Mohan, MD, MOC and Kristen L. Mackerel, Ph.D. King, MOC (Columbia Irving University Medical Center) examined information on all adult deceased recipients of kidney transplants from US donors. from 2000-2018.

Primary transplant recipients are more likely to be white, older, women, more educated, have private insurance, and have kidney failure not caused by diabetes or hypertension. The percentage of preventive transplants increased after KAS implementation from 9.0% to 9.8%, with a 10% higher probability of preventive transplantation after KAS was implemented than before. However, the increase in preventive transplantation was not evenly distributed across all patient groups. The socio-demographic and clinical differences in preventive transplantation that were present in the pre-KAS era still exist under the KAS, and the differences actually worsened in Black and Hispanic patients and in Medicare patients. Patients with private health insurance were 5 times more likely to receive a transplant prematurely, compared to Medicare patients.

"With a new focus on policy reforms on kidney disease and transplantation, our research can help inform where efforts are needed to achieve more equitable care for patients with kidney disease," Dr Mohan said. He noted that the US Executive Order on Improving Kidney Health, issued in July, indicated increased kidney transplantation and better treatment / prevention of kidney disease in its early stages as top priorities for improving kidney health in individuals in the United States. states.

The editorial notes that "factors related to access to nephrology before literal kidney disease, quality and timing of transplant education, eligibility for transplantation, and acceptance of preventive referral for transplantation, especially for racial / ethnic minority patients and patients with probably stands at the forefront of barriers to eliminating these differences. "


There are differences at the time of kidney transplant


More info:
Kristen L. King et al, Trends in Differences in Preventive Kidney Transplantation in the United States, Clinical Journal of the American Nephrology Association (2019). DOI: 10.2215 / CJN.03140319

"Permanent Differences in Preventive Kidney Transplantation", Clinical Journal of the American Nephrology Association (2019). DOI: 10.2215 / CJN.09800819.

Provided by
American Society of Nephrology

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Inequalities continue in early kidney transplantation despite policy changes (2019, September 26)
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