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Kidney Week

Abstract: SA-PO964

Racial Disparities Exist in the Transplant Process among Hispanic Patients on Dialysis

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical

Authors

  • Walker, Adam G., Davita Clinical Research, Minneapolis, Minnesota, United States
  • Colson, Carey, Davita Clinical Research, Minneapolis, Minnesota, United States
  • Radney, Danelle, DaVita Inc, Denver, Colorado, United States
  • Odama, Unini, DaVita Inc, Denver, Colorado, United States
  • Maixner, William D., DaVita Inc, Denver, Colorado, United States
  • Tentori, Francesca, Davita Clinical Research, Minneapolis, Minnesota, United States
  • Brunelli, Steven M., Davita Clinical Research, Minneapolis, Minnesota, United States
Background

Kidney transplantation is considered the best long-term treatment for patients with end-stage kidney disease (ESKD). Previous results revealed that African American patients are 54% less likely to receive a kidney transplant than White patients; we sought to examine if any disparities exist for Hispanic patients.

Methods

This retrospective study used electronic health records and county-level indices of socioeconomic deprivation at the time of dialysis initiation at a kidney care organization. Patients included in the study (n=50,102) were those who initiated dialysis between July 2015 and June 2018, were 18-80 years old, either Caucasian or Hispanic, and began care with a kidney care organization within 30 days of first ever dialysis. Patients with prior transplant or transplant evaluation/ listing were excluded. Patients were followed from date of first eligibility until 30 June 2022 or until censoring for death, transfer, withdrawal from dialysis, renal recovery, or loss to follow up. Outcomes included transplant referral, waitlisting, or receipt and were compared using time-to-event models. Models were adjusted for differences in patient demographic factors, comorbidities, laboratory values, and socioeconomic factors across exposure categories.

Results

Results indicate that the progression of Hispanic patients through the transplant process (referral, waitlisting, and receipt) varies by US region. Nearly half (47.1%) of all Hispanic patients on dialysis reside in the West region of the US, where they are ~35% less likely to receive a kidney transplant, primarily driven by a lower rate of conversion from waitlist to transplant. In the East region of the US, Hispanics are 40% less likely to receive a kidney, primarily driven by a lower rate of conversion from referral to waitlist. In all areas of the country, Hispanic patients were more likely to be referred for transplant evaluation.

Conclusion

In this sample, from the period 2015-2022, there were large and systematic biases against Hispanic patients that resulted in a lower likelihood of receiving a kidney transplant despite higher referral rates.