Salter Megan L, Gupta Natasha, King Elizabeth, Bandeen-Roche Karen, Law Andrew H, McAdams-DeMarco Mara A, Meoni Lucy A, Jaar Bernard G, Sozio Stephen M, Kao Wen Hong Linda, Parekh Rulan S, Segev Dorry L
Departments of Epidemiology and Johns Hopkins Center on Aging and Health, Baltimore, Maryland;
Departments of Surgery and.
Clin J Am Soc Nephrol. 2014 Nov 7;9(11):1940-8. doi: 10.2215/CJN.03310414. Epub 2014 Sep 11.
Disparities in kidney transplantation remain; one mechanism for disparities in access to transplantation (ATT) may be patient-perceived concerns about pursuing transplantation. This study sought to characterize prevalence of patient-perceived concerns, explore interrelationships between concerns, determine patient characteristics associated with concerns, and assess the effect of concerns on ATT.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Prevalences of 12 patient-perceived concerns about pursuing transplantation were determined among 348 adults who recently initiated dialysis, recruited from 26 free-standing dialysis centers around Baltimore, Maryland (January 2009-March 2012). Using variable reduction techniques, concerns were clustered into two categories (health-related and psychosocial) and quantified with scale scores. Associations between patient characteristics and concerns were estimated using modified Poisson regression. Associations between concerns and ATT were estimated using Cox models.
The most frequently cited patient-perceived concerns were that participants felt they were doing fine on dialysis (68.4%) and felt uncomfortable asking someone to donate a kidney (29.9%). Older age was independently associated with having high health-related (adjusted relative risk, 1.35 [95% confidence interval, 1.20 to 1.51], for every 5 years older for those ≥ 60 years) or psychosocial (1.15 [1.00 to 1.31], for every 5 years older for those aged ≥ 60 years) concerns, as was being a woman (1.72 [1.21 to 2.43] and 1.55 [1.09 to 2.20]), having less education (1.59 [1.08 to 2.35] and 1.77 [1.17 to 2.68], comparing postsecondary education to grade school or less), and having more comorbidities (1.18 [1.08 to 1.30] and 1.18 [1.07 to 1.29], per one comorbidity increase). Having never seen a nephrologist before dialysis initiation was associated with high psychosocial concerns (1.48 [1.01 to 2.18]). Those with high health-related (0.37 [0.16 to 0.87]) or psychosocial (0.47 [0.23 to 0.95]) concerns were less likely to achieve ATT (median follow-up time 2.2 years; interquartile range, 1.6-3.2).
Patient-perceived concerns about pursuing kidney transplantation are highly prevalent, particularly among older adults and women. Reducing these concerns may help decrease disparities in ATT.
肾移植方面的差异依然存在；获得移植机会（ATT）存在差异的一种机制可能是患者对寻求移植存在担忧。本研究旨在描述患者感知到的担忧的患病率，探究这些担忧之间的相互关系，确定与担忧相关的患者特征，并评估担忧对ATT的影响。
设计、地点、参与者及测量方法：在从马里兰州巴尔的摩市周边26个独立透析中心招募的348名近期开始透析的成年人中，确定了12种患者感知到的关于寻求移植的担忧的患病率（2009年1月至2012年3月）。使用变量约简技术，将担忧分为两类（与健康相关的和心理社会的），并用量表分数进行量化。使用修正泊松回归估计患者特征与担忧之间的关联。使用Cox模型估计担忧与ATT之间的关联。
最常被提及的患者感知到的担忧是参与者觉得自己透析情况良好（68.4%），以及觉得向别人请求捐肾不舒服（29.9%）。年龄较大独立与较高的与健康相关的担忧（≥60岁者每大5岁，调整后相对风险为1.35[95%置信区间，1.20至1.51]）或心理社会担忧（≥60岁者每大5岁，1.15[1.00至1.31]）相关，女性也是如此（分别为1.72[1.21至2.43]和1.55[1.09至2.20]），受教育程度较低（将高等教育与小学及以下学历相比，分别为1.59[1.08至2.35]和1.77[1.17至2.68]），以及合并症较多（每增加一种合并症，分别为1.18[1.08至1.30]和1.18[1.07至1.29]）。透析开始前从未看过肾病专家与较高的心理社会担忧相关（1.48[1.01至2.18]）。有较高的与健康相关的担忧（0.37[0.16至0.87]）或心理社会担忧（0.47[0.23至0.95]）的患者实现ATT的可能性较小（中位随访时间2.2年；四分位间距，1.6 - 3.2）。
患者对寻求肾移植的感知到的担忧非常普遍，尤其是在老年人和女性中。减少这些担忧可能有助于减少ATT方面的差异。
