Treatment Disparities Between Blacks, Whites With Kidney Failure

Ruzanna Harutyunyan's picture
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Research has found that although blacks "suffer from kidney disease at higher rates than whites, they are less likely to be referred for transplants, less likely to be placed on a waiting list and less likely to get kidneys once on the list," the Chicago Tribune reports. Kidney transplants are the recommended treatment for kidney failure, but there is a "glaring racial disparity in which many black kidney patients remain on dialysis," which is "associated with lower quality of life and higher death rates," the Tribune reports. Thirty-seven percent of people receiving dialysis are black but they comprise 19% of the transplant population, according to data from the United States Renal Data System.

Clive Callender, director of Howard University Hospital's Transplant Center, said that research suggests that blacks actually fare better than other races or ethnicities on dialysis, but he noted that such findings might not be completely accurate because "healthier blacks stay on the machine, while healthier whites get transplants." Callender added that the longer a patient remains on dialysis, the less likely he or she is to have a successful transplant.

Several factors contribute to fewer blacks receiving a transplant. One is the national transplant allocation system, which seeks to match patients with donors based on tissue types. Blacks are more likely to find a match with a donor who also is black, but a smaller percentage of donors are black, the Tribune reports. The transplant system recently has placed more emphasis on factors such as geographical proximity, which has somewhat reduced the gap in wait times between blacks and whites.

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Many patients on waiting lists for organs from deceased donors are seeking out living donors, but blacks are two-thirds less likely than others to find a living donor, Robert Gaston, a transplant nephrologist and medical director of kidney and pancreas transplantation at the University of Alabama-Birmingham, said. Conditions that often cause kidney failure, such as hypertension and diabetes, often run in black families, which "shrink the pool of potential donors," the Tribune reports.

Further, some research has shown that doctors are less likely to refer black patients to be evaluated for a kidney transplant, according to the Tribune.

In addition, cost can be a factor behind the kidney transplant disparity, the Tribune reports. Anti-rejection drugs patients must take after a transplant can cost between $10,000 and $20,000 annually. Medicare covers dialysis treatments for those diagnosed with kidney failure, but coverage for those who are younger than 65 and are not disabled ends three years after a successful transplant. According to the Tribune, advocates are lobbying Congress to eliminate that coverage limit.

Gaston said that even taking into account those factors, there is "still a gap that you can't explain" for blacks receiving fewer kidney transplants (Shelton, Chicago Tribune, 7/8).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Weekly Health Disparities Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Weekly Health Disparities Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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