Knowledge About Renal Transplantation Among African, Caribbean, and Black Canadian Patients With Advanced Kidney Failure

Marzan Hamid; Jasleen Gill; Princess Okoh; Nawang Yanga; Vardaan Gupta; Jing Chen Zhang; Navneet Singh; John Matelski; Priscilla Boakye; Carl E James; Amy Waterman; Istvan Mucsi

doi:10.1016/j.ekir.2023.09.018

Knowledge About Renal Transplantation Among African, Caribbean, and Black Canadian Patients With Advanced Kidney Failure

Kidney Int Rep. 2023 Sep 22;8(12):2569-2579. doi: 10.1016/j.ekir.2023.09.018. eCollection 2023 Dec.

Authors

Affiliations

¹ Multi-Organ Transplant Program and Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
² Stanford University School of Medicine, Stanford, California, USA.
³ Biostatistical Research Unit, University Health Network, University of Toronto, Toronto, Ontario, Canada.
⁴ Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada.
⁵ Jean Augustine Chair in Education, Community & Diaspora, Faculty of Education, York University, Toronto, Ontario, Canada.
⁶ Department of Surgery and J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, Texas, USA.

Abstract

Introduction: Variable transplant-related knowledge may contribute to inequitable access to living donor kidney transplant (LDKT). We compared transplant-related knowledge between African, Caribbean, and Black (ACB) versus White Canadian patients with kidney failure using the Knowledge Assessment of Renal Transplantation (KART) questionnaire.

Methods: This was a cross-sectional cohort study. Data were collected from a cross-sectional convenience sample of adults with kidney failure in Toronto. Participants also answered an exploratory question about their distrust in the kidney allocation system. Clinical characteristics were abstracted from medical records. The potential contribution of distrust to differences in transplant knowledge was assessed in mediation analysis.

Results: Among 577 participants (mean [SD] age 57 [14] years, 63% male), 25% were ACB, and 43% were White Canadians. 45% of ACB versus 26% of White participants scored in the lowest tertile of the KART score. The relative risk ratio to be in the lowest tertile for ACB compared to White participants was 2.22 (95% confidence interval [CI]: 1.11, 4.43) after multivariable adjustment. About half of the difference in the knowledge score between ACB versus White patients was mediated by distrust in the kidney allocation system.

Conclusion: Participants with kidney failure from ACB communities have less transplant-related knowledge compared to White participants. Distrust is potentially contributing to this difference.

Keywords: African; Caribbean and Black; health equity; kidney transplant knowledge.