Disparities in completion rates of the medical prerenal transplant evaluation by race or ethnicity and gender

Abstract

Background: A significant number of potential kidney transplant candidates do not complete the required medical evaluation after referral to a transplant program.

Methods: Factors associated with rate of completion of the renal transplant evaluation were analyzed using a retrospective chart review of patients first seen between October 1, 2009, and September 30, 2010 (n=256). The primary endpoint was completion in 12 months. Independent variables included socioeconomic, demographic, and medical factors.

Results: Mean age was 50.7 years; 49.6% were black, 28.5% Hispanic, and 21.9% white and other; 26.3% did not require dialysis. During follow-up, 23.4% did not complete the evaluation. Multivariable analysis indicated that slower rates of completion were associated with needing a greater number of medical tests (compared to 0-2: 3-5 tests, hazard ratio [HR]=0.65, P=0.02; ≥ 6 tests, HR=0.47, P=0.0005) and requiring more than one hospitalization (compared to none: HR=0.37, P=0.0008). A significant interaction between race or ethnicity and gender on completion was found: compared to black men, Hispanic men (HR=2.75, P<0.0001), Hispanic women (HR=1.96, P=0.006), and white men (HR=1.99, P=0.005) showed a more rapid completion. In comparison, black and white women (HR=1.38, P=0.16; HR=0.94, P=0.83, respectively) were not significantly different from black men in rates of completion. Differences by race or ethnicity and gender were not confounded by socioeconomic variables or social support.

Conclusion: To lessen barriers and facilitate renal transplantation, black men and women, white women, and patients needing multiple medical tests and requiring several hospitalizations may benefit from additional assistance during the medical evaluation process.

Figure 1

Kaplan-Meier Plots of Factors Significantly Associated with Completion of the Medical Pre-Renal Transplant Evaluation. a) Number of required medical tests; b) Number of hospitalizations; c) Race/ethnicity and gender.

Figure 2

Hazard Ratios for Factors Significantly Associated (p<0.05) with Completion of the Medical Pre-Renal Transplant Evaluation from the Final Multivariable Model. The bars plotted represent the log of the hazard ratio to account for the asymmetry of hazard ratios greater than and less than 1.0. Numbers next to the bars are the actual hazard ratios. Tests=number of required medical tests; Hosp=number of hospitalizations; NHW=Non-Hispanic white ^a p<0.05 ^b p<0.01