Kidney Donor Health and Care Gaps

Kidney transplantation issues discussed in three new studies

(RxWiki News) While kidney transplants can save lives, transplant recipients still face certain risks. And recipients are not the only ones who may face complications; donors may be at risk as well.

In three recent studies, researchers looked at how kidney transplantation affects the health of donors after transplant. Additionally, this study reviewed the racial gaps faced by children who need kidney transplants.

Results from the first two studies showed that some kidney donors may be more likely to develop high blood pressure after donation and that people with pre-diabetes can safely donate kidneys.

The third study found that black and Hispanic children with kidney disease may be less likely than whites to get the care they need.

"Become a kidney donor - save a life."

Studies have suggested that high blood pressure and diabetes are more common in black kidney donors than in white donors. However, these studies did not compare donors to healthy non-donors. As such, it remains unclear if the higher rates of high blood pressure and diabetes among blacks are caused by donation or other factors.

In the first study, Dorry Segev, MD, of Johns Hopkins University and colleagues found that non-black kidney donors had a 44 percent increased risk of high blood pressure after donation compared to healthy non-black people who did not donate a kidney.

Among black donors, there was no increased risk of high blood pressure compared to black non-donors.

"Interestingly, an increased risk was not seen in African American donors, despite the fact that this is the subgroup of donors where we particularly worry about this issue, because African American donors have higher rates of post-donation hypertension than non-African Americans," said Dr. Segev.

Dr. Segev added that this finding suggests that black donors have higher rates of high blood pressure than whites because blacks have higher rates of high blood pressure in general. In other words, this finding suggests that donating a kidney is not more harmful to blacks than to whites when it comes to the risk of high blood pressure.

Dr. Segev and colleagues also found that donors and non-donors may have similar rates of diabetes.

The study involved over 1,000 donors and more than 1,000 individuals who did not donate kidneys. In the second study, Sindhu Chandran, MD, of the University of California San Francisco, and colleagues set out to see if it was safe for people with pre-diabetes to donate a kidney.

Generally, people with pre-diabetes are not allowed to donate kidneys for fear that they will go on to develop diabetes or kidney failure. That is, living with one kidney may increase their risk of developing diabetes or kidney failure.

Dr. Chandran and colleagues found that only 11.4 percent (about four patients) of pre-diabetic kidney donors develop diabetes within 10 years. All pre-diabetic kidney donors maintained good kidney function.

This second study was small, with only 35 participants. As such, more research is needed to verify the findings. However, if the results are confirmed, it could mean more donors and more kidneys available to patients.

"One in three US adults is pre-diabetic, and this is often a barrier to kidney donation. Our findings hold the potential to help us safely expand living kidney donation," said Dr. Chandran.

The third study - which was conducted by Roshan George, MD, of Emory University and Children's Healthcare of Atlanta, and colleagues - looked at racial gaps in care among children with advanced kidney disease.

As kidney disease worsens, patients need treatment to replace the function of their kidneys. Kidney replacement therapy involves either dialysis or transplantation.

Dialysis is a process in which an external machine takes over the kidneys' job of filtering blood. There are different types of dialysis, and research has shown that certain types are more beneficial than others.

From their study, Dr. George and colleagues found that black and Hispanic children with kidney disease were less likely than whites to receive peritoneal dialysis or to receive a transplant before needing dialysis.

Socioeconomic status (i.e. wealth), access to care and other demographic factors may be to blame for this racial gap among Hispanics, but not among blacks.

Generally, transplantation is the preferred treatment for failing kidneys. However, there are more patients waiting for transplants than there are kidneys available. Dialysis is the next option for patients.

In many cases, peritoneal dialysis is preferred over hemodialysis. While peritoneal dialysis can be done at home or at work, hemodialysis requires a rigorous treatment schedule in which patients normally have to visit a clinic three times a week for 3-4 hours.

According to Dr. George, transplantation before dialysis or home-based peritoneal dialysis may improve outcomes in several ways when compared to hemodialysis. Unfortunately, the study's results showed that more black and Hispanic patients are on hemodialysis.

Dr. George added that these racial gaps may be reduced through addressing certain modifiable factors, including access to care, early referral and improving education about treatment options. Addressing these factors could improve long-term outcomes among minorities with kidney disease, said Dr. George.

This third study included 5,623 patients. Of these, 43.3 percent were white, 30.3 percent were black and 26.4 percent were Hispanic.

All three of these studies were presented at the American Society of Nephrology's Annual Kidney Week. As such, the research still needs to be reviewed by a body of peers.

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Review Date: 
November 5, 2012