Kidney transplant is the optimal treatment for people with end-stage renal disease (ESRD). These patients typically must stay on renal dialysis until a donor kidney becomes available. For a patient to even be considered for a kidney transplant, their nephrologist must first recommend them as a suitable candidate. However, nephrologists' recommendations are influenced by nonclinical as well as clinical factors, according to a study supported by the Agency for Healthcare Research and Quality (HS08365).
Researchers from Johns Hopkins Medical Institutions, the Independent Dialysis Foundation, and New England Medical Center conducted a national random survey of 271 U.S. nephrologists. Most participants were white and male. The researchers gauged nephrologists' basis for transplant recommendations based on their response to eight unique patient scenarios in which the characteristics of patients were randomly assigned.
For example, one scenario presented a 52-year-old white male who lived alone, was compliant with treatment, was diabetic, weighed more than 200 pounds, and had no residual kidney function. Another case was a 47-year-old black female who lived alone, was not compliant with treatment, had HIV disease, was not diabetic, weighed less than 200 pounds, and had no residual renal function. All patients had started dialysis within the past 3 months. Nephrologists were less likely to recommend patients with the following clinical characteristics: history of treatment noncompliance, less than 25 percent cardiac ejection fraction (indicative of cardiovascular disease), HIV infection, and weight over 200 pounds.
All clinical factors being equal, white men were almost 2.5 times as likely as white women and white women were equally as likely as black women to be recommended for transplantation. Asian men were half as likely as white men to be recommended. There were no differences in recommendation rates overall for blacks versus whites. The well-documented black-white disparities in use of renal transplantation documented elsewhere may be due to unaccounted for factors in this study or arise later in the transplantation process. Nephrologists' demographic characteristics, experience, and training did not appear to influence their kidney transplant recommendations.
More details are in "U.S. nephrologists' attitudes toward renal transplantation: Results from a national survey," by Mae Thamer, Ph.D., Wenke Hwang, Ph.D., Nancy E. Fink, M.P.H., and others, in the January 27, 2001 Transplantation 71(2), pp. 281-288.