Dietary Restriction, Socioeconomic Factors, Access to Kidney Transplantation, and Waitlist Mortality

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2024-10-20 DOI:10.1111/ctr.70001

Emily A. Johnston, Jingyao Hong, Akanksha Nalatwad, Yiting Li, Byoungjun Kim, Jane J. Long, Nicole M. Ali, Barbara Krawczuk, Aarti Mathur, Babak J. Orandi, Joshua Chodosh, Dorry L. Segev, Mara A. McAdams-DeMarco

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Abstract

Introduction

Dietary restrictions for patients with end-stage kidney disease (ESKD) are burdensome. Kidney transplantation (KT) candidates who lack neighborhood resources and are burdened by dietary restrictions may have decreased access to KT.

Methods

In our two-center prospective cohort study (2014–2023), 2471 ESKD patients who were evaluated for KT (candidates) reported their perceived burden of dietary restrictions (not at all, somewhat/moderately, or extremely bothered). Neighborhood-level socioeconomic factors were derived from residential ZIP codes. We quantified the association of perceived burden of the dietary restrictions with a chance of listing using Cox models and risk of waitlist mortality using competing risks models. Then we tested whether these associations differed by neighborhood-level socioeconomic factors.

Results

At evaluation, 18% of KT candidates felt extremely bothered by dietary restrictions. Those who felt extremely bothered were less likely to be listed for KT (adjusted hazard ratio [aHR] = 0.75, 95% confidence interval [CI]: 0.64–0.87); this association did not differ by neighborhood-level socioeconomic factors. Overall, the burden of dietary restrictions was not associated with waitlist mortality (p = 0.62). However, among candidates living in high food insecurity neighborhoods, those who felt extremely bothered had higher waitlist mortality (adjusted subhazard ratio [aSHR] = 2.07, 95% CI: 1.14–3.75, p_{[interaction]} = 0.02). The association between dietary burden and waitlist mortality did not differ by neighborhood-level healthy food access.

Conclusion

The perceived burden of dietary restrictions is associated with a lower chance of listing for KT, and higher waitlist mortality only among candidates residing in neighborhoods with high food insecurity. Transplant centers should identify vulnerable patients and support them with nutrition education and access to food assistance programs.

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饮食限制、社会经济因素、肾移植机会和候选者死亡率

导言：终末期肾病（ESKD）患者的饮食限制是一种负担。缺乏邻里资源并因饮食限制而负担沉重的肾移植（KT）候选者可能会减少接受 KT 的机会。方法在我们的双中心前瞻性队列研究（2014-2023 年）中，2471 名接受肾移植评估的 ESKD 患者（候选者）报告了他们认为的饮食限制负担（完全没有、有点/中等程度或极度困扰）。邻里层面的社会经济因素来自住宅邮政编码。我们使用 Cox 模型量化了饮食限制的感知负担与列名几率的关系，并使用竞争风险模型量化了候补名单上的死亡风险。然后，我们检验了这些关联是否因邻近地区的社会经济因素而有所不同。结果在评估时，18% 的 KT 候选人感到饮食限制带来了极大的困扰。那些感到极度困扰的人被列入 KT 名单的可能性较低（调整后危险比 [aHR] = 0.75，95% 置信区间 [CI]：0.64-0.87）；这种关联并不因邻近地区的社会经济因素而有所不同。总体而言，饮食限制与候选者死亡率无关（p = 0.62）。然而，在食物高度不安全社区的候选者中，那些感到极度困扰的人的候选死亡率较高（调整后次危险比 [aSHR] = 2.07，95% CI：1.14-3.75，p[交互作用] = 0.02）。饮食负担与候选者死亡率之间的关系并不因邻里健康食品获取情况的不同而有所差异。结论只有居住在食物高度不安全社区的患者才会认为饮食限制负担与较低的 KT 候选机会和较高的候选死亡率相关。移植中心应识别易受伤害的患者，并通过营养教育和食品援助计划为他们提供支持。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.