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Race, insurance status affect access to transplantation and kidney disease treatment
Date:2/27/2008

Universal access to health care might help to overcome racial and ethnic barriers to treatment for kidney disease, suggest two studies in the March 2008 issue of Clinical Journal of the American Society of Nephrology.

The results should be seen as "yet another wake-up call as to how we as a medical community need to lead the health agenda for the nation, including the reduction and/or elimination of health disparities," according to an editorial by Dr. Keith Norris of Charles Drew University and Dr. Allen Nissenson of the David Geffen School of Medicine at UCLA.

In one of the two new studies, Dr. Douglas Keith of McGill University, Montreal, and colleagues analyzed data on nearly 76,000 U.S. patients wait-listed for kidney transplantation between 2001 and 2004. The goal was to identify factors affecting time on dialysis before being placed on the waiting listthe less time a patient spends on dialysis, the better the results of transplantation.

During the four-year study period, there was a significant increase in the rate of "pre-emptive listing"that is, being placed on the transplant waiting list before starting dialysis. However, the median time spent on dialysis before wait-listing was essentially unchanged.

The rate of pre-emptive listing was lower, and time spent on dialysis was longer, for minority patients and for patients on Medicare (compared to those on private insurance).

Less-educated patients and those whose kidney disease was caused by high blood pressure also had a reduced rate of pre-emptive wait-listing and a longer time on dialysis. On average, a minority patient who was on Medicare and had less than a high school education spent 20 times longer on dialysis before being wait-listed, compared to a white patient with private insurance and at least a high school education.

The impact of insurance was greatly reduced after age 65. At that age, Medicare patients no longer have to go through
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Contact: Shari Leventhal
sleventhal@asn-online.org
202-416-0658
American Society of Nephrology
Source:Eurekalert

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