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Racial Disparities in Eligibility for Preemptive Waitlisting for Kidney Transplantation and Modification of eGFR Thresholds to Equalize Waitlist Time.
Ku, Elaine; McCulloch, Charles E; Adey, Deborah B; Li, Libo; Johansen, Kirsten L.
  • Ku E; Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, California elaine.ku@ucsf.edu.
  • McCulloch CE; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.
  • Adey DB; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.
  • Li L; Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, California.
  • Johansen KL; Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, California elaine.ku@ucsf.edu.
J Am Soc Nephrol ; 32(3): 677-685, 2021 03.
Artigo em Inglês | MEDLINE | ID: covidwho-1496676
ABSTRACT

BACKGROUND:

Patients may accrue wait time for kidney transplantation when their eGFR is ≤20 ml/min. However, Black patients have faster progression of their kidney disease compared with White patients, which may lead to disparities in accruable time on the kidney transplant waitlist before dialysis initiation.

METHODS:

We compared differences in accruable wait time and transplant preparation by CKD-EPI estimating equations in Chronic Renal Insufficiency Cohort participants, on the basis of estimates of kidney function by creatinine (eGFRcr), cystatin C (eGFRcys), or both (eGFRcr-cys). We used Weibull accelerated failure time models to determine the association between race (non-Hispanic Black or non-Hispanic White) and time to ESKD from an eGFR of ≤20 ml/min per 1.73 m2. We then estimated how much higher the eGFR threshold for waitlisting would be required to achieve equity in accruable preemptive wait time for the two groups.

RESULTS:

By eGFRcr, 444 CRIC participants were eligible for waitlist registration, but the potential time between eGFR ≤20 ml/min per 1.73 m2 and ESKD was 32% shorter for Blacks versus Whites. By eGFRcys, 435 participants were eligible, and Blacks had 35% shorter potential wait time compared with Whites. By the eGFRcr-cys equation, 461 participants were eligible, and Blacks had a 31% shorter potential wait time than Whites. We estimated that registering Blacks on the waitlist as early as an eGFR of 24-25 ml/min per 1.73 m2 might improve racial equity in accruable wait time before ESKD onset.

CONCLUSIONS:

Policies allowing for waitlist registration at higher GFR levels for Black patients compared with White patients could theoretically attenuate disparities in accruable wait time and improve racial equity in transplant access.
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Texto completo: Disponível Coleções: Bases de dados internacionais Base de dados: MEDLINE Assunto principal: Listas de Espera / Transplante de Rim / Insuficiência Renal Crônica / Disparidades em Assistência à Saúde / Racismo / Taxa de Filtração Glomerular Tipo de estudo: Estudo de coorte / Estudo experimental / Estudo observacional / Estudo prognóstico / Ensaios controlados aleatorizados Limite: Idoso / Feminino / Humanos / Masculino / Meia-Idade País/Região como assunto: América do Norte Idioma: Inglês Revista: J Am Soc Nephrol Assunto da revista: Nefrologia Ano de publicação: 2021 Tipo de documento: Artigo

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Texto completo: Disponível Coleções: Bases de dados internacionais Base de dados: MEDLINE Assunto principal: Listas de Espera / Transplante de Rim / Insuficiência Renal Crônica / Disparidades em Assistência à Saúde / Racismo / Taxa de Filtração Glomerular Tipo de estudo: Estudo de coorte / Estudo experimental / Estudo observacional / Estudo prognóstico / Ensaios controlados aleatorizados Limite: Idoso / Feminino / Humanos / Masculino / Meia-Idade País/Região como assunto: América do Norte Idioma: Inglês Revista: J Am Soc Nephrol Assunto da revista: Nefrologia Ano de publicação: 2021 Tipo de documento: Artigo