Racial and Ethnic Disparities in Graft and Recipient Survival in Elderly Kidney Transplant Recipients

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134926/1/jgs13845_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134926/2/jgs13845.pd

Factors affecting willingness to receive a kidney transplant among minority patients at an urban safety-net hospital: a cross-sectional survey

Abstract Background In the US, African Americans (AAs) are four times more likely to develop end stage renal disease (ESRD) but half as likely to receive a kidney transplant as whites. Patient interest in kidney transplantation is a fundamental step in the kidney transplant referral process. Our aim was to determine the factors associated with the willingness to receive a kidney transplant among chronic kidney disease (CKD) patients in a predominantly minority population. Methods CKD patients from an outpatient nephrology clinic at a safety-net hospital (n = 213) participated in a cross-sectional survey from April to June, 2013 to examine the factors associated with willingness to receive a kidney transplant among a predominantly minority population. The study questionnaire was developed from previously published literature. Multivariable logistic regression analysis was used to determine factors associated with willingness to undergo a kidney transplant. Results Respondents were primarily AAs (91.0 %), mostly female (57.6 %) and middle aged (51.6 %). Overall, 53.9 % of participants were willing to undergo a kidney transplant. Willingness to undergo a kidney transplant was associated with a positive perception towards living kidney donation (OR 7.31, 95 % CI: 1.31–40.88), willingness to attend a class about kidney transplant (OR = 7.15, CI: 1.76–29.05), perception that a kidney transplant will improve quality of life compared to dialysis (OR = 5.40, 95 % CI: 1.97–14.81), and obtaining information on kidney transplant from other sources vs. participant’s physician (OR =3.30, 95 % CI: 1.13–9.67), when compared with their reference groups. Conclusion It is essential that the quality of life benefits of kidney transplantation be known to individuals with CKD to increase their willingness to undergo kidney transplantation. Availability of multiple sources of information and classes on kidney transplantation may also contribute to willingness to undergo kidney transplantation, especially among AAs.http://deepblue.lib.umich.edu/bitstream/2027.42/116033/1/12882_2015_Article_186.pd

Multivitamin Use and Serum Vitamin B12 Concentrations in Older-Adult Metformin Users in REGARDS, 2003-2007.

Metformin, an insulin-sensitizing drug, is a first line treatment for type 2 diabetes. Long-term use of metformin has been associated with subsequent reductions in vitamin B12 concentrations. The objective of our study was to determine whether metformin use is associated with lower serum vitamin B12 concentrations in older adults, and whether concurrent use of multivitamins modifies this association. We examined 2,510 participants aged 50 years and over, participating in the national population-based Reasons for Geographic And Racial Differences in Stroke (REGARDS) Study. Multivariable linear and logistic regression models were used to assess associations between multivitamin use and serum vitamin B12 concentrations. We estimated adjusted odds ratios (aOR)s and confidence intervals (CI)s. Results were stratified by three metformin/diabetes sub-groups: 1) participants with diabetes who were metformin users; 2) participants with diabetes who were not metformin users; and 3) participants without diabetes. We found that diabetic metformin users had significantly lower geometric mean serum B12 concentrations (409 pmol/L) than the group with diabetes not taking metformin (485 pmol/L; P<0.01), and the group without diabetes (445 pmol/L; P = 0.02). The geometric mean serum B12 concentrations were greater for multivitamin users (509 pmol/L) compared to those who did not use multivitamins (376 pmol/L; p<0.01). Among the participants with diabetes who were on metformin therapy, multivitamin use was associated with geometric mean serum vitamin B12 concentrations that were 50% (or 161 pmol/L) higher, compared to those not using multivitamins. Among metformin users, multivitamin use was associated with lower prevalence of combined low and borderline vitamin B12 concentrations (aOR = 0.14; 95% CI = 0.04, 0.54) compared to those not using multivitamins. In conclusion, metformin use was associated with lower geometric mean serum vitamin B12 concentrations among diabetic older adults compared to their counterparts. Concurrent multivitamin use may potentially protect against low or borderline vitamin B12 concentrations in long-term metformin users. Additional research is needed to further examine this association as low or borderline vitamin B12 concentrations can be preventable, or treatable if detected at an early stage, in long-term metformin users

Prevalence of normal, borderline and low vitamin B12 concentrations, and its association with multivitamin use, stratified by diabetes/metformin status—REasons for Geographic And Racial Differences in Stroke, 2003–2007.

<p>Gray = % with normal serum B12 concentration; White = % with borderline serum B12 concentration; Black = % with low serum B12 concentration. *Unadjusted odds ratio (and 95% CI) for low B12 concentration and multivitamin use. †Unadjusted odds ratio (and 95% CI) for borderline B12 concentration (148–221 pmol/L vs. > 221 pmol/L) and multivitamin use. ‡Unadjusted odds ratio (and 95% CI) for combined low and borderline B12 concentration (≤221 pmol/L vs. > 221 pmol/L) and multivitamin use. ¶ Adjusted odds ratio (and 95% CI) for combined low and borderline B12 concentration (≤221 pmol/L vs. > 221 pmol/L) and multivitamin use, controlling for race, gender, geographic region, body mass index, alcohol use, smoking, insulin use, and age. OR = Odds Ratio; CI = Confidence Interval; MV = multivitamin; ref = Reference.</p

Demographic and Clinical Characteristics of Older Adults (50 years or older) by Multivitamin use and by Diabetes/Metformin Use Status—REasons for Geographic And Racial Differences in Stroke (N = 2510), 2003–2007.

<p>Demographic and Clinical Characteristics of Older Adults (50 years or older) by Multivitamin use and by Diabetes/Metformin Use Status—<u>RE</u>asons for <u>G</u>eographic <u>A</u>nd <u>R</u>acial <u>D</u>ifferences in <u>S</u>troke (N = 2510), 2003–2007.</p

Modeled geometric mean serum vitamin B12 concentrations and 95% confidence intervals stratified by diabetes/metformin status—REasons for Geographic And Racial Differences in Stroke, 2003–2007.

<p>Adjusted for race, gender, geographic region, body mass index, alcohol use, smoking, insulin use, and age (all at their population mean levels). White = Multivitamin user; Black = Non-multivitamin user. *Totals are reduced due to missing data.</p

Subject selection criteria—REasons for Geographic And Racial Differences in Stroke, 2003–2007.

<p>Subject selection criteria—<u>RE</u>asons for <u>G</u>eographic <u>A</u>nd <u>R</u>acial <u>D</u>ifferences in <u>S</u>troke, 2003–2007.</p