Kidney patients know little about transplant benefits

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[September 20, 2014]  By Ronnie Cohen

NEW YORK (Reuters Health) - In a new study, the vast majority of kidney failure patients told researchers they saw no need for a kidney transplant because they were doing fine on dialysis – but the researchers say these patients might not realize how much a transplant could help them.

“Nobody is doing fine on dialysis to the point where a transplant wouldn’t be better for them,” senior author Dr. Dorry Segev told Reuters Health. “Transplantation is the better form of renal replacement.”

A kidney transplant doubles a recipient’s life expectancy, said Segev, a transplant surgeon at the Johns Hopkins Hospital in Baltimore, Maryland.

His group’s study, published in the Clinical Journal of the American Society of Nephrology, showed a gap in dialysis patients’ knowledge about the benefits of transplants over dialysis, Segev said.

Researchers surveyed 348 patients being treated at 26 Baltimore-area freestanding dialysis centers, asking whether a dozen potential concerns constituted reasons they would not pursue a transplant. The average age was 56 and half the patients had been on dialysis for at least two months.

Overall, more than 68 percent of the patients told researchers “I’m doing fine on dialysis.”

The older the patient, the more likely they were to report feeling fine on dialysis, the study found.

Less educated patients were more likely to report being content with dialysis than those with higher degrees, the study found.

Almost a quarter of patients had not seen a nephrologist (a doctor who specializes in kidney disease) before starting dialysis – and these people were almost twice as likely to report that no one had discussed a possible transplant with them.

Nearly 30 percent of participants reported feeling uncomfortable asking a friend or relative to donate a kidney, the study found. The authors say such reluctance to ask friends and relatives to donate kidneys is consistent with prior studies.

Also consistent with prior studies, the researchers found that women tended to be more fearful about transplants than men, with 26 percent of women saying they feared a transplant compared to less than eight percent of the men.

Women do just as well after a transplant as men, if not better, Segev said. “That’s another area where we need to work on education and assurance,” he said.

In sum, he said, the study points to a lack of education for renal-failure patients about the benefits of kidney transplants.

“This is another set of evidence that we have a problem in how well we are educating people at the time of their kidney disease,” he said. “We really need to find a better way to educate people about transplantation.”

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Jesse Schold agreed. He has done similar research at the Cleveland Clinic but was not involved with the current study.

“The preponderance of research shows that transplantation doubles life expectancy, improves quality of life and reduces healthcare costs,” he told Reuters Health.

“It’s certainly interesting and to most people would be relatively startling” to realize how many patients aren’t pursuing transplantation because they say they’re doing fine, he said.

“Given the overwhelming evidence that transplantation is a better treatment modality, it certainly suggests that more education may be appropriate.”

Schold stressed the need for patients suffering from renal failure to see nephrologists and learn about transplants soon after they are diagnosed with renal problems.

Prior research found that kidney-disease patients who are African-American or lack private health insurance are less likely to be matched with donor organs before they need dialysis (see Reuters Health story of January 31, 2013 here:

Almost 66 percent of the current study participants were African-American. Some 24 percent of them reported feeling uncomfortable asking someone to donate a kidney, compared to 41 percent of other participants.

Americans who receive kidneys from unrelated live donors tend to be white, highly educated and live in wealthier neighborhoods, according to an earlier study (see Reuters Health story of April 9, 2012 here:

A kidney is one of the few organs people can give away and go on to live a healthy life.

Since the 1990s, advances in immune-suppression have made it safer to receive an organ from someone who’s not a relative. Less-invasive surgical techniques also make it easier to donate.

SOURCE: Clinical Journal of the American Society of Nephrology, online September 11, 2014.

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