title: Impact of race on predialysis discussions and kidney transplant preemptive wait-listing.
abstract: OBJECTIVE
  US registry data have consistently shown that blacks are less likely than whites to be wait-listed before beginning dialysis.
  
  
  METHODS
  The Comprehensive Dialysis Study (CDS) was a special study conducted by the US Renal Data System (USRDS) in which a national cohort of patients who began maintenance dialysis therapy in 2005-2007 were asked whether kidney transplantation (KT) had been discussed with them before they started dialysis. Using responses from black and white CDS participants and information from the USRDS, we investigated preemptive wait-listing as a function of patient-reported predialysis KT discussion.
  
  
  RESULTS
  Among those reporting early KT discussion, 31.0% of patients preemptively wait-listed were black, compared to 27.5% of those not preemptively wait-listed. Two thirds of preemptively wait-listed patients had received nephrology care more than 12 months before starting dialysis and reported that KT was discussed with them 12 months or more before dialysis. Early KT discussion and higher serum albumin and hemoglobin levels remained significant predictors of preemptive wait-listing in an adjusted logistic regression analysis. Among those preemptively wait-listed, 33% of blacks and 60% of whites had received a transplant by September 30, 2009 (study end date).
  
  
  CONCLUSIONS
  Early KT discussion appeared to reduce barriers to black patients' waiting list placement before the start of dialysis, which in turn may facilitate earlier access to a deceased donor organ transplant.
authors.affiliation: United States Renal Data System, Rehabilitation/Quality of Life Special Studies Center, Emory University, Atlanta, Ga., USA. nkutner@emory.edu
authors.forename: Nancy G
authors.initials: NG
authors.lastname: Kutner
authors.forename: Rebecca
authors.initials: R
authors.lastname: Zhang
authors.forename: Yijian
authors.initials: Y
authors.lastname: Huang
authors.forename: Kirsten L
authors.initials: KL
authors.lastname: Johansen
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D037001:Directive Counseling; D005260:Female; D054625:Healthcare Disparities; D006454:Hemoglobins; D006801:Humans; D007407:Interviews as Topic; D007676:Kidney Failure, Chronic / Q000628:therapy; D016030:Kidney Transplantation / Q000208:ethnology* / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D006435:Renal Dialysis; D012709:Serum Albumin; D013997:Time Factors; D014481:United States; D014850:Waiting Lists; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D006454:Hemoglobins; D012709:Serum Albumin