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

Publication ,  Journal Article
Salter, ML; Gupta, N; King, E; Bandeen-Roche, K; Law, AH; McAdams-DeMarco, MA; Meoni, LA; Jaar, BG; Sozio, SM; Kao, WHL; Parekh, RS; Segev, DL
Published in: Clin J Am Soc Nephrol
November 7, 2014

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.

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Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

November 7, 2014

Volume

9

Issue

11

Start / End Page

1940 / 1948

Location

United States

Related Subject Headings

  • Waiting Lists
  • Urology & Nephrology
  • United States
  • Sex Factors
  • Renal Dialysis
  • Patient Acceptance of Health Care
  • Nephrology
  • Middle Aged
  • Male
  • Living Donors
 

Citation

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Salter, M. L., Gupta, N., King, E., Bandeen-Roche, K., Law, A. H., McAdams-DeMarco, M. A., … Segev, D. L. (2014). Health-related and psychosocial concerns about transplantation among patients initiating dialysis. Clin J Am Soc Nephrol, 9(11), 1940–1948. https://doi.org/10.2215/CJN.03310414
Salter, Megan L., Natasha Gupta, Elizabeth King, Karen Bandeen-Roche, Andrew H. Law, Mara A. McAdams-DeMarco, Lucy A. Meoni, et al. “Health-related and psychosocial concerns about transplantation among patients initiating dialysis.Clin J Am Soc Nephrol 9, no. 11 (November 7, 2014): 1940–48. https://doi.org/10.2215/CJN.03310414.
Salter ML, Gupta N, King E, Bandeen-Roche K, Law AH, McAdams-DeMarco MA, et al. Health-related and psychosocial concerns about transplantation among patients initiating dialysis. Clin J Am Soc Nephrol. 2014 Nov 7;9(11):1940–8.
Salter, Megan L., et al. “Health-related and psychosocial concerns about transplantation among patients initiating dialysis.Clin J Am Soc Nephrol, vol. 9, no. 11, Nov. 2014, pp. 1940–48. Pubmed, doi:10.2215/CJN.03310414.
Salter ML, Gupta N, King E, Bandeen-Roche K, Law AH, McAdams-DeMarco MA, Meoni LA, Jaar BG, Sozio SM, Kao WHL, Parekh RS, Segev DL. Health-related and psychosocial concerns about transplantation among patients initiating dialysis. Clin J Am Soc Nephrol. 2014 Nov 7;9(11):1940–1948.

Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

November 7, 2014

Volume

9

Issue

11

Start / End Page

1940 / 1948

Location

United States

Related Subject Headings

  • Waiting Lists
  • Urology & Nephrology
  • United States
  • Sex Factors
  • Renal Dialysis
  • Patient Acceptance of Health Care
  • Nephrology
  • Middle Aged
  • Male
  • Living Donors