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Clin J Am Soc Nephrol. 2014 Nov 7;9(11):1940-8. doi: 10.2215/CJN.03310414. Epub 2014 Sep 11.

Health-related and psychosocial concerns about transplantation among patients initiating dialysis.

Author information

1
Departments of Epidemiology and Johns Hopkins Center on Aging and Health, Baltimore, Maryland;
2
Departments of Surgery and.
3
Johns Hopkins Center on Aging and Health, Baltimore, Maryland; Biostatistics, Johns Hopkins School of Public Health, Baltimore, Maryland;
4
Departments of Epidemiology and Departments of Surgery and.
5
Biostatistics, Johns Hopkins School of Public Health, Baltimore, Maryland; Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland;
6
Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland; Nephrology Center of Maryland, Baltimore, Maryland;
7
Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland;
8
Departments of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland;
9
Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Nephrology, Hospital for Sick Children, University Health Network, Toronto, Ontario, Canada; and Departments of Pediatrics and Medicine, University of Toronto, Toronto, Ontario, Canada.
10
Departments of Epidemiology and Departments of Surgery and dorry@jhmi.edu.

Abstract

BACKGROUND AND OBJECTIVES:

Disparities in kidney transplantation remain; one mechanism for disparities in access to transplantation (ATT) may be patient-perceived concerns about pursuing transplantation. This study sought to characterize prevalence of patient-perceived concerns, explore interrelationships between concerns, determine patient characteristics associated with concerns, and assess the effect of concerns on ATT.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

Prevalences of 12 patient-perceived concerns about pursuing transplantation were determined among 348 adults who recently initiated dialysis, recruited from 26 free-standing dialysis centers around Baltimore, Maryland (January 2009-March 2012). Using variable reduction techniques, concerns were clustered into two categories (health-related and psychosocial) and quantified with scale scores. Associations between patient characteristics and concerns were estimated using modified Poisson regression. Associations between concerns and ATT were estimated using Cox models.

RESULTS:

The most frequently cited patient-perceived concerns were that participants felt they were doing fine on dialysis (68.4%) and felt uncomfortable asking someone to donate a kidney (29.9%). Older age was independently associated with having high health-related (adjusted relative risk, 1.35 [95% confidence interval, 1.20 to 1.51], for every 5 years older for those ≥ 60 years) or psychosocial (1.15 [1.00 to 1.31], for every 5 years older for those aged ≥ 60 years) concerns, as was being a woman (1.72 [1.21 to 2.43] and 1.55 [1.09 to 2.20]), having less education (1.59 [1.08 to 2.35] and 1.77 [1.17 to 2.68], comparing postsecondary education to grade school or less), and having more comorbidities (1.18 [1.08 to 1.30] and 1.18 [1.07 to 1.29], per one comorbidity increase). Having never seen a nephrologist before dialysis initiation was associated with high psychosocial concerns (1.48 [1.01 to 2.18]). Those with high health-related (0.37 [0.16 to 0.87]) or psychosocial (0.47 [0.23 to 0.95]) concerns were less likely to achieve ATT (median follow-up time 2.2 years; interquartile range, 1.6-3.2).

CONCLUSIONS:

Patient-perceived concerns about pursuing kidney transplantation are highly prevalent, particularly among older adults and women. Reducing these concerns may help decrease disparities in ATT.

KEYWORDS:

ESRD; barriers; dialysis; epidemiology; outcomes; transplantation

PMID:
25212908
PMCID:
PMC4220760
DOI:
10.2215/CJN.03310414
[Indexed for MEDLINE]
Free PMC Article

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