Black kidney failure patients can now get transplant lists sooner
Crystal Higgins just wants to be healthy, become a nurse and travel to Greece. But she has kidney failure and has been on the transplant waiting list for six years.
The illness and its co-morbidities have affected many of her loved ones. Her mother suffers from stage two kidney disease. Her father has diabetes, which is a risk factor for kidney failure, as does her late grandmother. Many of her relatives suffer from kidney failure.
Blacks are four times as likely to be He was diagnosed with kidney failure As white people – but often diagnosed late and It takes longer to get transplant listings.
This is because of an outdated renal function test that could overestimate renal function in black patients, masking the severity of their kidney disease and leading to late diagnoses and late transplant referrals.
The test has attracted scrutiny from experts in recent years. Last summer, the Council launched the Organ Procurement and Transplant Network, which connects transplant centers and develops policies, Account use is prohibited.
And in what experts call an unprecedented step to correct racial inequality in access to kidney transplants, the board recently approved a Waiting time adjustment For black kidney transplant candidates.
It’s a “restorative justice project in medicine,” said Dr. Martha Pavlakis, a nephrologist and chair of the Kidney Transplant Committee at OPTN.
The new deferral policy, which went into effect earlier this month, aims to make up for that lost time for black kidney transplant candidates who should have been eligible for transplant sooner but didn’t because their kidney function wasn’t severe enough. According to Exam.
The policy requires kidney transplant programs to identify and notify black candidates who should be eligible sooner. The programs have a year to identify patients and apply to OPTN for waiting time adjustments.
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Blacks and African Americans represent a Disproportionately 35% of patients with renal failure in the countryDespite being 13% of the population. Nearly 27,500 black patients are on the kidney transplant list — representing 30% of candidates nationwide, according to the United Network for Organ Sharing.
Wait times vary across the country, but the average is three to five years, according to the National Kidney Foundation.
It’s “a marathon to do a kidney transplant,” said Dr. Paolo Martins, chair of the OPTN’s Minority Affairs Committee. For too long, he said, black patients had been “five miles behind.”
Higgins’ friend died in 2020 while awaiting a kidney transplant. The two met in a New York City hospital while on dialysis three times a week. The black woman was the mother of five children.
Higgins, now a patient advocate for the National Kidney Foundation, couldn’t help but wonder, “What if her time could be shortened?”
Experts say the eGFR test mistakenly keeps some from the transplant list
Estimated glomerular filtration rate, or eGFR test, is the formula most commonly used to calculate how well patients’ kidneys are working by measuring creatinine, a waste product in the blood caused by muscle use.
Black people in the original studies to develop the test may have been exposed to non-biological risks that affected their creatinine levels, such as medications or dietary differences. But scientists, in trying to explain these differences, have concluded that black people have more “muscle mass” and, therefore, a higher baseline level of creatinine.
This is not proven by “rigorous scientific evidence”, The experts wrote in one scientific editorial Detailing the effect of equivalence on systemic inequality in renal transplants, published in the Journal of the American Medical Association. The researchers wrote that the formula “systematically raises” kidney function by up to 16% for blacks compared to all other ethnic groups.
“The fact that we as a medical community, in the 1990s when this (account) came out, embraced it without questioning it is part of a pattern of these unsubstantiated race-based assumptions that ended up having profound effects in perpetuating the disease,” said Pavlakis, medical director of Transplant. Kidneys and Pancreas at Beth Israel Deaconess Medical Center.
When Nicole Jefferson, a patient with kidney failure, needed a second kidney transplant, doctors at a senior hospital told her she didn’t qualify. They said her kidney function wasn’t low enough according to the test.
Jefferson is a national patient advocate who had her first transplant in 2003. So She knew a lot to stand up for – she even asked them to list her as white.
said Jefferson, president of Home Dialyzors United and a member of the Texas Chronic Kidney Disease Task Force and the American Association of Justice and Healthcare Committee on Nephrology.
The Dallas woman was able to get listed at other hospitals, and finally got a life-saving transplant in 2020. But looking back at the experience, she says it made her feel rejected.
“I really felt left out,” she said. “I felt like I was being punished because of my race.”
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In August 2020 — the month Higgins’ friend died — the American Association of Nephrology and the National Kidney Foundation formed military unit To re-evaluate the equation and its harms and to suggest a fairer account.
Dr Nwamaka Eneanya, a member of the task force as well as the Minority Affairs Committee of OPTN, said the adjustment of transplant times is “enormous”. You helped lead the effort to A new, fairer equation.
“It’s the least we can do to help, to try to reverse some of this damage,” Inanya said. Chief of Strategy and Operations in Fresenius Medical Care’s global medical office, who had to advocate for her own relative to get the transplant list.
While other researchers argue To support the equation, Inanya said the attempt at accuracy did not take into account other races and lumped all blacks into a separate category. Rather than driving with race, which is not a biological construct, the way forward needs to account for measures of structural racism and how these affect health, she said.
“We strongly support this new policy, which will help hold the American health care system accountable for discriminatory action that has harmed black Americans for years by underestimating the severity of their disease,” said LaVarne Burton, president and CEO of the American Kidney Foundation. Fund, in a statement to USA TODAY.
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“Essential” for the field
Lack of early detection can contribute to poor disease management, lack of patient education, and limited access to new medications or therapies that can slow disease progression.
tolerances Access also hinders the care of black patients long before they are diagnosed with kidney failure.
Kidney disease care before dialysisfor example, was shown on Low death and hospitalization rates. And although this treatment overall increased between 2005 and 2015, the disparities remained the same, according to study Published in the Journal of the American Medical Association. During the two-year period in the analysis, Black adults were 18% less likely than white adults to receive this care for at least a year.
Distances between patients and caregivers can also be an issue. Higgins drives 40 miles round trip to Memphis from Olive Branch, Mississippi, for dialysis treatments three times a week. Before that, she was paying out of pocket for truck transportation because she didn’t feel safe driving by herself.
The new account should be part of the larger effort to address these disproportionate obstacles to kidney care, said Dr. Dinushika Mohotig, a nephrologist and member of the NKF Transplantation Advisory Committee and assistant professor at the Mount Sinai School of Medicine.
That includes “policies that truly prevent and manage kidney disease, that correct disparities by race in terms of access to health insurance, access to food, and access to disease-modifying drugs that can actually slow the progression of kidney disease,” she said. .
The new policy It could be a beacon for other inequalities in medicine, experts say. If there are past practices that “we can actually correct, we should include them retroactively in our scientific and medical innovations,” Inyaña said.
“This is actually a model for other algorithms based on race and how we can correct some of the damage of the past,” Inanya said, calling it “fundamental.”
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