NEW YORK, N.Y.—Original research, published in the November issue of the American Journal of Nursing (AJN), found that 60 percent of non-transplanted patients with kidney disease perceive transplantation as a “last-resort” option. This is despite the fact that those who receive kidney transplants before starting dialysis have lower rates of morbidity and mortality than those who undergo transplantation after dialysis. In 2005, fewer than 2.5 percent of patients in the United States with end-stage kidney disease underwent transplantation as initial therapy.
“The survey found that emotional barriers or gaps in education are the two major factors behind the misperception that dialysis must precede transplantation,” said Genevieve Coorey, MA, BSN, RN, quality assurance and program director at the National Kidney Foundation. “Patients need to be taught that avoiding even a year of chronic dialysis can significantly improve health outcomes.” Coorey noted that transplantation can also decrease Medicare expenditure by about $58,000 (34 percent) per patient over the first two years of kidney replacement therapy.
To explore barriers to early transplantation, in 2007 the National Kidney Foundation (NKF) surveyed 3,586 patients randomly selected from its database. The 28-question survey focused on socioeconomic factors, perceptions, fears and concerns about living donor transplantation and barriers to learning about transplant as a treatment option.
Results indicated that those who received transplants before starting dialysis had higher incomes and more education. They were also more likely to be white and to have learned about treatment options from a physician. Barriers to early transplantation among patients with progressive kidney disease include the lack of a timely referral by a health professional and the fact that patients are not always informed that transplantation has better outcomes when pursued early. There are also financial considerations and potential psychosocial barriers, such as anxiety and misunderstanding about the process, along with reservations about finding and approaching a potential living donor.
“As the author points out, this survey indicates that both real and perceived barriers to early transplantation persist,” said Diana J. Mason, RN, PhD, FAAN, editor-in-chief emeritus of AJN. “The responses reveal how vital the nurse’s role is for reinforcing the importance of timely education, problem solving, advocacy and facilitating patient-physician communication if early transplantation is to become a reality.”
Source: National Kidney Foundation
