Summary of Condition Burden and Impact. Half a million people in the U.S. have end-stage renal disease (ESRD), with disproportionately higher rates among minorities. Blacks, for instance, have the highest overall risk of ESRD, with an incidence rate that is four times higher than in whites. Dialysis, deceased donor kidney transplant, and live donor kidney transplantation (LDKT) are the three treatments available for ESRD. Compared to the other options, LDKT yields longer survival, lower all-cause hospitalization rates, and better quality of life. However, there are profound racial and income disparities in LDKT access. Minorities, especially blacks, are much less likely to receive LDKT than whites. Also, the overall decline in LDKTs in the U.S. in recent years has been more pronounced for blacks and low-income patients. These lower LDKT rates contribute to longer transplant waiting times, more dialysis exposure, higher mortality risk before transplantation, declining functional capacity, less optimal outcomes after transplantation, and higher healthcare costs. Interventions that expand access to LDKT, especially for minority populations, are needed given the current and projected shortage of deceased donor organs.
The House Calls educational intervention. More than a decade ago, the PI of this study, Dr. James Rodrigue, developed the House Calls (HC) intervention in which personalized LDKT and living donation information is delivered in the patient’s home by transplant health educators and includes the patient’s social network. Two completed randomized control trials (RCT) examined the effectiveness of the House Calls intervention at increasing LDKT with a third study currently in progress. The two RCTs found that participants who had took part in a House Calls intervention had higher rates living donor inquiries, evaluations, and rates of live donor kidney transplants. Black patients in particular were shown to have benefited from the program with a fourfold increase in LDKT among black participants in the first trial.
The addition of a peer mentorship (PM) program may enhance the House Calls effect. While overall ratings about the House Calls program, its educators, and its helpfulness have all been outstanding, 78% of patients stated that some type of follow-up service or intervention would have been helpful to them. Additionally, many participants felt it would be helpful to talk to a patient who had a LDKT. The current application, therefore, seeks to expand the House Calls intervention to include a peer mentorship component that addresses these issues and to determine whether this adds incremental benefit to the House Calls intervention.
Peer mentorship programs have the potential to provide patients with successful models of those who have encountered similar barriers yet still achieved the benefits of LDKT. Patients may be more receptive to guidance and counsel provided by another patient who is similar to them in important ways (e.g., kidney disease, race, age, etc.). Additionally, peer mentorship may be more widely available to patients at no or minimal cost, particularly since they can be accessed remotely in many instances. In light of these potential benefits, the National Kidney Foundation developed and implemented a nationwide telephone-based peer mentoring program designed to provide patients with peer role models for transplant decision-making. Although Peer mentorship (PM) programs have shown promise in reducing disparities in healthcare and increasing living liver donor inquires, they have never been evaluated with kidney transplant patients. This study, in partnership with the NKF, seeks to determine whether PM can enhance the effectiveness of the HC approach for increasing access to LDKT in black patients.