Black dialysis patients in US less likely to be placed on transplant waiting list.

Blacks in the United States are less likely than whites to move forward in the kidney transplantation process while they are receiving hemodialysis, according to a multistate analysis of possible transplant candidates.

G. Caleb Alexander, MD of the University of Pennsylvania in Philadelphia

and Ashwini Sehgal, MD of Case Western Reserve University in Cleveland evaluated data from the Renal Network's database of patients in Indiana, Kentucky, and Ohio. Included were patients who began chronic dialysis therapy between 1993-1996, representing approximately 8% of the US dialysis patients. Their analysis indicated inefficiencies in the transplantation process, particularly among black patients, the investigators reported in the February issue of the American Journal of Kidney Diseases. Black patients, for example, were more likely than white patients to remain unsure about transplantation and also were less likely to complete the pretransplantation workup.

"Providing education to these patients about the benefits of transplantation may help them move forward in the process," said Alexander. He also recommended establishing a national registry to maintain data on hemodialysis patients, with this information "used to design quality improvement initiatives for individual dialysis facilities."

In a related commentary, Glenn Chertow, MD of the University of California in San Francisco and Stefanos Zenios of Stanford (CA) University wrote that "we should not suggest that hemodialysis patients 'fail to complete' the transplantation process. Rather, the system fails to meet the needs of blacks."