title: Sex differences and attitudes toward living donor kidney transplantation among urban black patients on hemodialysis.
abstract: OBJECTIVE
  Living donor kidney transplantation, the treatment of choice for ESRD, is underused by women and blacks. To better understand sex differences in the context of potential barriers to living donor kidney transplantation, the Dialysis Patient Transplant Questionnaire was administered in two urban, predominantly black hemodialysis units.
  
  
  METHODS
  The Dialysis Patient Transplant Questionnaire was designed to study barriers to kidney transplantation from previously validated questions. Between July of 2008 and January of 2009, the Dialysis Patient Transplant Questionnaire was administered to 116 patients on hemodialysis, including potentially eligible and ineligible living donor kidney transplantation candidates. Of 101 patients who self-identified as black or African American, 50 (49.5%) patients had the questionnaire entirely administered by the researcher or assistant, 25 (24.8%) patients required some assistance, and 26 (25.7%) patients completed the Dialysis Patient Transplant Questionnaire entirely by themselves. Multiple logistic regression methods were used to determine if the observed bivariate associations and differences persisted when controlled for potential confounders.
  
  
  RESULTS
  Women were less likely to want living donor kidney transplantation compared with men (58.5% versus 87.5%, P=0.003), despite being nearly two times as likely as men to receive unsolicited offers for kidney transplant (73.2% versus 43.2%, P=0.02). They were also less likely to have been evaluated for a kidney transplant (28.3% versus 52.2%, P=0.01). The multiple logistic regression analysis showed that sex was a statistically significant predictor of wanting living donor kidney transplantation (women versus men odds ratio, 0.13; 95% confidence interval, 0.04 to 0.46), controlling for various factors known to influence transplant decisions. A sensitivity analysis indicated that mode of administration did not bias these results.
  
  
  CONCLUSIONS
  In contrast to previous studies, the study found that black women were less likely to want living donor kidney transplantation compared with black men. Black women were also less likely to be evaluated for a kidney transplant, although they were more likely to receive an unsolicited living donor kidney transplantation offer.
authors.affiliation: Department of Medicine, Section of Nephrology and Kidney Transplantation, Temple University School of Medicine, Philadelphia, Pennsylvania; avrum.gillespie@tuhs.temple.edu.
authors.forename: Avrum
authors.initials: A
authors.lastname: Gillespie
authors.affiliation: Health Group and.
authors.forename: Heather
authors.initials: H
authors.lastname: Hammer
authors.affiliation: Advanced Methods Group, Abt SRBI, Inc., Silver Spring, Maryland;
authors.forename: Stanislav
authors.initials: S
authors.lastname: Kolenikov
authors.affiliation: Center for Data Analytics and Biomedical Informatics, Temple University, Philadelphia, Pennsylvania;
authors.forename: Athanasia
authors.initials: A
authors.lastname: Polychronopoulou
authors.affiliation: Center for Data Analytics and Biomedical Informatics, Temple University, Philadelphia, Pennsylvania;
authors.forename: Vladimir
authors.initials: V
authors.lastname: Ouzienko
authors.affiliation: Center for Data Analytics and Biomedical Informatics, Temple University, Philadelphia, Pennsylvania;
authors.forename: Zoran
authors.initials: Z
authors.lastname: Obradovic
authors.affiliation: Department of Abdominal Organ Transplantation, Temple University Hospital, Philadelphia, Pennsylvania; and.
authors.forename: Megan A
authors.initials: MA
authors.lastname: Urbanski
authors.affiliation: College of Social Work, University of South Carolina, Columbia, South Carolina.
authors.forename: Teri
authors.initials: T
authors.lastname: Browne
authors.affiliation: Department of Medicine, Section of Nephrology and Kidney Transplantation, Temple University School of Medicine, Philadelphia, Pennsylvania;
authors.forename: Patricio
authors.initials: P
authors.lastname: Silva
mesh_terms: D001741:Black or African American / Q000523:psychology*; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000208:ethnology / Q000523:psychology / Q000628:therapy*; D016030:Kidney Transplantation / Q000523:psychology*; D019520:Living Donors / Q000523:psychology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D015143:Philadelphia / Q000453:epidemiology; D006435:Renal Dialysis / Q000523:psychology*; D012737:Sex Factors; D011795:Surveys and Questionnaires; D014504:Urban Health
keywords: ESRD; ethnicity; kidney donation; kidney transplantation