Lower Socio-Economic Status is Associated with Reduced Readiness to Pursue Living Donor Kidney Transplant: A Pilot Study

2016 CST-CNTRP-SQT Joint Scientific Meeting Abstract Submission

Abstract Organization: CST

Abstract Type: Adult

Science Type: Clinical

Abstract Category: Kidney-Pancreas

Submission: Both

Trainee: Yes, Luke S. Dingwell1; Supervisor: Dr. Istvan Mucsi1,4, istvan.mucsi@utoronto.ca

Abstract Title: Lower Socio-Economic Status is Associated with Reduced Readiness to Pursue Living Donor Kidney Transplant: A Pilot Study

Co-Authors and Co-Author Affiliations: Luke, Dorothy Wong1, Heather Ford1, Luca Ugenti1, Dmitri Belenko1, Yalinie Kulandaivelu1, Eleanor Warsmann1, Marta Novak, Amy Waterman, Istvan Mucsi1,4

1Multi-Organ Transplant Program, Toronto General Hospital, Toronto, Canada

2Centre for Mental Health, University Health Network and Department of Psychiatry, University of Toronto, Canada

3 University of California at Los Angeles, Los Angeles, CA, USA

4Division of Nephrology, Toronto General Hospital, Toronto, Canada

Abstract Body:

Background: Patient level factors, including socioeconomic status (SES) as well as ethnocultural and psychosocial characteristics, may be associated with reduced access to kidney transplantation (KT). In this pilot study we assessed the associations between SES and 1) KT-related knowledge and 2) readiness to pursue deceased donor (DD) or living donor (LD) KT in patients on maintenance dialysis.

Methods: Between September 2015 and April 2016 we enrolled a convenience sample of 107 patients on maintenance dialysis (³18 years) using a tablet-based electronic data capture system. Fifty-eight patients completed the Transplant Decision Making Survey, a validated questionnaire. KT-related knowledge was defined as low (<75th percentile) or high (>75th percentile), and readiness as early or late, as adapted from the Transtheoretical Model of Behavioral Change. SES was defined as “lower” or “higher” using the combination of self-reported income (<$30,000/yr, $30-70,000/yr, >$70,000/yr) and years of education (<8 yrs, 8-12 yrs, >12 yrs). Descriptive statistics, c2  test, and logistic regression were used; p<0.05 was considered significant.

Results: Of the 58 patients, 39% were female and 41% were diabetic with a mean (±SD) age of 59 (±15) years. Forty-eight percent of patients were of “lower” SES. Seventeen percent of patients of “lower” vs. 40% of “higher” SES scored high on KT-related knowledge (p=0.099). Forty-one percent of patients of “lower” vs. 65% of “higher” SES exhibited late-stage DDKT readiness (p=0.140). Thirty-nine percent of patients of “lower” vs. 74% of “higher” SES exhibited late-stage LDKT readiness (p=0.025). This association remained significant upon multi-variable adjustment for age, sex, ethnicity, and comorbidity (OR=5.19, 95%CI=1.10–24.38; p=0.037).

Conclusion: Lower SES was associated with reduced readiness to pursue LDKT, and trends toward reduced KT-related knowledge and DDKT readiness were observed. These preliminary results suggest that patients of lower SES face additional barriers to accessing KT, and may require more tailored support.

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