Project Details
Description
Abstract
Kidney transplantation (KTx) is considered the preferred treatment for patients with end-stage kidney
disease. Despite recent changes to the kidney allocation Black and Hispanic individuals are less likely
to receive KTx, a multi-step process requiring patient referral, patient medical/surgical/psychosocial
evaluation, and patient waitlisting. As there are no standardized acceptable metrics for psychosocial
evaluations, each of steps is impacted by provider and patient bias and thwarted by social determinants
often overlooked and structural racism continues to drive of racial and ethnic disparities in KTx. We
have identified barriers and facilitators to evaluation and waitlisting for KTx, including provider bias, high
unmet social determinants of health and symptom burden in patients on hemodialysis. To address the
impact of structure racism on KTx, we now propose a multi-level intervention in full partnership with an
Executive Stakeholder Board and Workgroups comprised of patients, clinicians, caregivers, advocates,
and system leaders for dialysis organizations and transplant centers. This work will be built on 2
decades of community-engaged research and trials to improve health in diverse populations. We will
work with the Board to develop an intervention based on past work by our team and others,
supplemented by formative interview with patients, caregivers, and clinicians. To increase rates of
patients receiving KTx evaluation, patient navigators who have chronic kidney disease and waitlisted
for kidney transplant or are transplant recipients themselves will guide patients through the transplant
evaluation process. This will include conducting a social needs screen and addressing barriers
uncovered, including facilitating appointments to address unmet needs such as food insecurity and
transportation, control of symptoms and mental health challenges. To increase rates of waitlisting
among those evaluated, we will identify stigmatizing language from KTx providers; notes and provide
an anti-bias initiative including structural changes to evaluation and education for KTx nephrologists.
We will evaluate the impact of this multifactorial intervention in a clinical trial among 320 adults with an
eGFR
Status | Active |
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Effective start/end date | 9/1/23 → 6/30/24 |
Funding
- National Institute of Diabetes and Digestive and Kidney Diseases: $859,062.00
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