SAN FRANCISCO—Obesity is one of the reasons African Americans are less likely to become live kidney donors than whites, researchers reported here at the 2007 American Transplant Congress.
“Obesity is a growing problem in the African-American community, particularly among women, and this reflects what we found in the study,” said study investigator Amber Reeves-Daniel, DO, an instructor at Wake Forest University School of Medicine in Winston-Salem, N.C. “The other issue is the social reasons for non-donation, including failure to complete the donor evaluation process.”
Dr. Reeves-Daniel and her colleagues reviewed donor questionnaires and charts from 541 disqualified potential donors and found that about 30% of African Americans were excluded because of obesity—defined as a BMI of 32 kg/m2 or greater—compared with 16.6% of whites.
In addition, 12% of African Americans were excluded because they did not entirely complete the evaluation process, compared with 1.8% of whites surveyed. More whites were excluded for kidney stones than blacks (7.3% vs. 1.5%).
African Americans represent 12% of the U.S. population, but they make up 35% of the national kidney transplant waiting list, Dr. Reeves-Daniel noted. Previous studies have found that blacks were less likely to be referred for transplantation, had longer waiting times, and were less likely to receive a kidney transplant compared with whites.
“Further study of these differences may improve our understanding of the causes of low rates of living kidney donation among African Americans, particularly regarding the social issues,” Dr. Reeves-Daniel said. “Is it lack of trust in the medical community, financial inability to get to doctors’ appointments for certain tests, concerns with work and child-care scheduling, or perhaps some other issue?”
The researchers also found that more women than men of both races did not donate because of reduced renal function (7.9% for women vs. 0.9% for men). In addition, more women (6.4%) than men (1.8%) were excluded as a result of not completing the donation process. “I did find this kind of surprising because more women successfully donate than men, at a rate of 58% vs. 42%,” Dr. Reeves-Daniel observed.
The researchers said this study should serve as a wake-up call for clinicians. Study co-investigator Erica Hartmann, MD, assistant professor in the department of internal medicine/nephrology at Wake Forest, said a closer look needs to be paid to BMI cutoff points.
Some potential donors with higher BMIs may need to be considered in some cases, she said. In addition, she called for “targeted education strategies for the African-American donors who are interested to see if we can help them get through the process.”