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Author Notes:

Sumit Mohan, Division of Nephrology, Department of Medicine, Columbia University Medical Center, 622 West 168th Street, Ph4-124, New York, New York 10032, USA. Email: sm2206@cumc.columbia.edu

SM and SAH conceptualized the study; SM, SAH, and KLK were responsible for data curation and methodology; KLK and VS were responsible for formal analysis and visualization; SM was responsible for funding acquisition, resources, and supervision; SM, SAH, KLK, and VS were responsible for writing the original draft, and all authors interpreted results, reviewed, and edited the manuscript.

The data reported here have been supplied by the United Network for Organ Sharing as the contractor for the Organ Procurement and Transplantation Network. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the OPTN or the U.S. Government. This work was supported in part by Health Resources and Services Administration contract 234-2005-370011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. This work was presented as an abstract at the June 2022 American Transplant Congress meeting in Boston, MA, USA.

SM receives grant funding from Kidney Transplant Collaborative and the NIH, and personal fees from Kidney International Reports and Health Services Advisory Group outside of the submitted work. SM was supported by NIH grants DK114893, DK116066, DK126739, DK130058 and MD014161 and a Nelson Family Faculty Development Award. SAH was supported by a Nelson Family Faculty Development Award and NIDDK grant K23DK133729. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. All others have no competing interests.

Subjects:

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Urology & Nephrology
  • estimated glomerular filtration rate
  • eGFR
  • kidney transplant
  • waitlisting
  • disparities
  • RACE
  • DIALYSIS
  • SURVIVAL
  • DISEASE
  • HEALTH
  • IMPACT

Contribution of Estimates of Glomerular Filtration to the Extensive Disparities in Preemptive Listing for Kidney Transplant

Tools:

Journal Title:

KIDNEY INTERNATIONAL REPORTS

Volume:

Volume 8, Number 3

Publisher:

, Pages 442-454

Type of Work:

Article | Final Publisher PDF

Abstract:

Introduction: The use of race coefficients in equations for estimated glomerular filtration rate (eGFR) may have contributed to racial disparities in access to preemptive (without dialysis exposure) kidney transplantation (Ktx). Methods: In this retrospective national cohort study of incident kidney transplant candidates in the United States from 2001 to 2019, we describe temporal trends and racial disparities in preemptive listing and the distribution of eGFR at listing, using eGFR as reported and after removing the race coefficient for Black candidates. Results: Among 511,686 candidates, preemptive listing increased over time, from 18% in 2001 to 33% in 2019. Non-Black candidates were listed preemptively nearly twice as frequently as Black candidates in 2019 (38% vs. 21% preemptive) and at higher eGFR values (median 15.6 vs. 15.0 ml/min per 1.73 m2). After adjusting for candidate characteristics, including listing eGFR without the race coefficient, preemptive Black candidates still had significantly lower odds of preemptive deceased donor (DD) kidney transplantation compared to non-Black candidates (odds ratio 0.87, 95% confidence interval: 0.78−0.98). Conclusions: Over the last 2 decades, Black patients were consistently less likely to be listed preemptively and were listed at lower eGFR values. Adjusting for listing eGFR with the race coefficient computationally removed did not eliminate the racial disparity, suggesting that additional efforts are needed to achieve equity in preemptive transplantation beyond adopting race-free eGFR equations.

Copyright information:

© 2022 Published by Elsevier Inc. on behalf of the International Society of Nephrology.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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