Perspectives on the New Kidney Disease Education Benefit: Early Awareness, Race and Kidney Transplant Access in a USRDS Study

• Type of Material: Article
• Authors: Nancy Kutner, Emory University; K.L. Johansen, Emory University; R. Zhang, Emory University; Yijian Huang, Emory University; S. Amaral, Children's Hospital of Philadelphia
• Language: English
• Date: 2012-04-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2011 The American Society of Transplantation and the American Society of Transplant Surgeons.
• Final Published Version (URL): http://dx.doi.org/10.1111/j.1600-6143.2011.03898.x
• Title of Journal or Parent Work: American Journal of Transplantation
• ISSN: 1600-6135
• Volume: 12
• Issue: 4
• Start Page: 1017
• End Page: 1023
• Grant/Funding Information: The interpretation and reporting of the data presented here are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the US government.; This study was supported by National Institutes of Health contract HHSN267200715004C, ADB No. N01-DK-7-5004 (Dr. Kutner).
• Keywords: STAGE RENAL-DISEASE; Access to transplantation; kidney transplantation; HEMODIALYSIS; PATIENT EDUCATION; United States Renal Data System; Science & Technology; patient education; waiting list; Surgery; Life Sciences & Biomedicine; Transplantation; DIALYSIS; African Americans
• Research Categories: Health Sciences, Rehabilitation and Therapy; Health Sciences, Medicine and Surgery

Abstract

Education services for Stage-IV chronic kidney disease patients were added in 2010 as a Part B covered benefit under the Medicare Improvements for Patients and Providers Act. Desired outcomes include early pursuit of kidney transplantation by more patients and reduction of racial disparities in access to transplantation. During 2005-2007, a United States Renal Data System (USRDS) special study surveyed 1123 patients in a national cohort who had recently started dialysis, identified themselves as black or white, and were reported by their physician as potentially eligible transplant candidates. Patients were asked if kidney transplantation had been discussed with them before they initiated renal replacement therapy, and survey responses were linked with subsequent wait listing and transplant events in USRDS registry files. Kaplan-Meier analyses showed a significant association between early transplant awareness and subsequent wait listing. Adjusted Cox models showed a significant race/early transplant awareness interaction, however, with the impact of early awareness on wait listing much stronger for whites. Ongoing support and education about kidney transplantation for patients after dialysis start could help to build on early education and foster greater quality improvement in patient outcomes.