Race, insurance status related to likelihood of being assessed for kidney transplantation

Young black patients and patients without private health insurance are less likely to be assessed for a kidney transplant when they start dialysis, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). These patients are also less likely to be put on the transplant waiting list and to receive a transplant.

A kidney transplant is the best treatment for a patient with kidney failure. When patients start dialysis, they should be assessed for a kidney transplant so they can be referred to a transplant center and be placed on the transplant waiting list if they are eligible.

In 2005, Medicare began collecting data on whether patients were informed of their transplant options when they started dialysis. When Kirsten Johansen, MD (University of California, San Francisco), Rachel Patzer, PhD (Emory University School of Medicine), and their colleagues at the USRDS Rehabilitation/Quality of Life Special Studies Center analyzed these and other data from 2005 to 2009, they found that young (< 35 years) black patients and patients without private insurance were less likely to be assessed for a transplant when they started dialysis. "This is particularly important because young kidney disease patients stand to benefit the most from a kidney transplant," said Dr. Patzer.

The investigators also found that patients who were not assessed at the start of dialysis were less likely to be put on the transplant waiting list and to receive a transplant. The findings may help partially explain the racial and socioeconomic disparities in access to kidney transplantation that are well documented.

"Disparities in the assessment of patients for transplant could be reduced with interventions designed to encourage providers to assess patients as early as possible in the course of late-stage chronic kidney disease and diagnosis of kidney failure," said Dr. Patzer.