Awareness of Racial Disparities in Kidney Transplantation among Health Care Providers in Dialysis Facilities

Clin J Am Soc Nephrol. 2018 May 7;13(5):772-781. doi: 10.2215/CJN.09920917. Epub 2018 Apr 12.


Background and objectives: Despite the important role that health care providers at dialysis facilities have in reducing racial disparities in access to kidney transplantation in the United States, little is known about provider awareness of these disparities. We aimed to evaluate health care providers' awareness of racial disparities in kidney transplant waitlisting and identify factors associated with awareness.

Design, setting, participants, & measurements: We conducted a cross-sectional analysis of a survey of providers from low-waitlisting dialysis facilities (n=655) across all 18 ESRD networks administered in 2016 in the United States merged with 2014 US Renal Data System and 2014 US Census data. Awareness of national racial disparity in waitlisting was defined as responding "yes" to the question: "Nationally, do you think that African Americans currently have lower waitlisting rates than white patients on average?" The secondary outcome was providers' perceptions of racial difference in waitlisting at their own facilities.

Results: Among 655 providers surveyed, 19% were aware of the national racial disparity in waitlisting: 50% (57 of 113) of medical directors, 11% (35 of 327) of nurse managers, and 16% (35 of 215) of other providers. In analyses adjusted for provider and facility characteristics, nurse managers (versus medical directors; odds ratio, 7.33; 95% confidence interval, 3.35 to 16.0) and white providers (versus black providers; odds ratio, 2.64; 95% confidence interval, 1.39 to 5.02) were more likely to be unaware of a national racial disparity in waitlisting. Facilities in the South (versus the Northeast; odds ratio, 3.05; 95% confidence interval, 1.04 to 8.94) and facilities with a low percentage of blacks (versus a high percentage of blacks; odds ratio, 1.86; 95% confidence interval, 1.02 to 3.39) were more likely to be unaware. One quarter of facilities had >5% racial difference in waitlisting within their own facilities, but only 5% were aware of the disparity.

Conclusions: Among a limited sample of dialysis facilities with low waitlisting, provider awareness of racial disparities in kidney transplant waitlisting was low, particularly among staff who may have more routine contact with patients.

Keywords: African Americans; Awareness; Censuses; Cross-sectional Studies; ESKD; ESRD; Humans; Kidney Failure, Chronic; Nurse Administrators; Perception; Physician Executives; Surveys and Questionnaires; United States; United States Renal Data System; dialysis; kidney; kidney transplantation; organ transplant; renal dialysis; transplantation.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • African Americans
  • Awareness
  • Cross-Sectional Studies
  • Female
  • Health Personnel*
  • Healthcare Disparities*
  • Humans
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • Renal Dialysis*
  • Waiting Lists*