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Education, outreach increases kidney transplant referrals from dialysis facilities

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Holly Korschun

Georgia has the lowest kidney transplant rates in the United States and significant racial disparities in transplantation. An educational and outreach program in Georgia dialysis centers in 2014 resulted in a 75 percent increase in referrals for kidney transplant evaluation, with the greatest increase among black patients.

The results will be published on Oct. 14 in the Journal of the American Society of Nephrology. Rachel Patzer, PhD, MPH, assistant professor of surgery at Emory University School of Medicine, was first author, and Stephan Pastan, MD, Emory professor of medicine (nephrology), was senior author.

The program was part of a randomized pragmatic trial conducted in 134 Georgia dialysis facilities treating a total of more than 9,000 patients with end stage renal disease (ESRD) in more than one-third of all dialysis facilities in the state. Patients were randomized to either an intervention group or a control group with standard practice but no intervention.

In the intervention group, the percentage of black patients with ESRD who were referred for transplant evaluation increased from 10 percent to 16 percent over the one-year period. In the control group, referrals decreased among black patients from 11.8 percent to 10 percent. Among white kidney failure patients, the percentage of patients referred for transplant in the intervention facilities increased from 9.6 percent to 10.6 percent, and decreased from 7.8 percent to 7 percent in control facilities.

The study, named Reducing Disparities in Access to kidney Transplantation Community Study (RaDIANT), was a multicomponent intervention designed to increase referral of patients on dialysis for transplant evaluation. In December 2013 the research team selected dialysis facilities with either low transplant referral or racial disparities in referral. The intervention, conducted from January to December 2014, included transplant education and engagement activities targeting dialysis facility leadership, staff and patients. These included talks at dialysis centers by former patients, and educational webinars for clinical staff about common barriers faced by patients and potential solutions.

Long-standing research shows that black patients are less likely than white patients to receive a kidney transplant. The researchers note that although many modifiable barriers leading to racial disparities exist before patients are waitlisted for transplant, few interventions have been conducted to reduce disparities in the early steps of the transplant process.

"This work could not have been done without our committed group of academic and community partners in our Southeastern Kidney Transplant Coalition, says Patzer. "The multicomponent educational and outreach intervention that our Coalition developed together substantially improved kidney transplant referral and reduced racial disparity, and we are working to adapt it for use by other ESRD networks and other members of the kidney community."

Longer-term follow-up is needed to confirm whether the RaDIANT Community Study helped to reduce disparities in subsequent access to kidney transplantation, the authors say.

Study co-authors included Sudeshna Paul, PhD, Laura Plantinga, PhD, Jennifer Gander, PhD, Leighann Sauls, RN, CDN, Jenna Krisher, Laura Mulloy, DO, Eric M. Gibney, MD, Teri Browne, PhD, MSW, Carlos F. Zayas, MD, William M. McClellan, MD, MPH, and Kimberly Jacob Arriola, PhD.

Dr. Pastan is a minority shareholder in Fresenius College Park Dialysis, College Park, Ga. The authors acknowledge the assistance of the Southeastern Kidney Council, Inc., and the Centers for Medicare & Medicaid Services (CMS) in providing data that made this research possible. The RaDIANT study was funded in part by the National Institute of Minority Health and Health Disparities award R24MD008077.

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