WASHINGTON - Because of improved antiretroviral therapies in recent years, HIV-infected individuals are living long enough to develop chronic conditions. Among African Americans, HIV infection is increasingly recognized as an important risk factor for developing chronic kidney disease. African American men and women are more likely to die from the complications of HIV infection compared with Caucasian men and women. To see if racial disparities also exist in the rates of kidney disease progression and death among HIV-infected individuals, Tahira Alves, MD, T. Alp Ikizler, MD, Todd Hulgan, MD (Vanderbilt University Medical Center) and their colleagues studied the health of 2468 HIV-infected patients cared for at the Comprehensive Care Center in Nashville from 1998 through 2005. Rates of kidney function decline were similar in African American and non-African American HIV-infected individuals, but African Americans were more likely to develop kidney failure or end-stage renal disease and had a higher risk of dying during the study period. "It is likely that the current observations result from the interaction of multiple factors, including, but not limited to, possible genetic, social, and other clinical risk factors," the authors noted. The findings warrant further exploration and may have significant public health implications.
For patients with severe chronic kidney disease, the best treatment option is usually a kidney transplant from a living donor. Unfortunately, African American and older patients are much less likely than patients of other races or ages to receive kidney transplants from living donors. A recent study by Francis Weng, MD (Saint Barnabas Medical Center) and his colleagues found that African American or older kidney transplant candidates were less likely to have friends or family members contact their transplant center to volunteer as possible living kidney donors. Furthermore, African American or older kidney transplant candidates who did have potential living donors were still less likely to receive living donor kidney transplants. The researchers studied 1617 kidney transplant candidates, 791 (48.9%) of whom recruited at least one potential living donor and 452 (28.0%) of whom received living donor kidney transplants. Compared with candidates of other races, African American transplant candidates were less likely to receive living kidney donor transplants (20.5% versus 30.6%), recruit potential living donors (43.9% versus 50.7%), and receive living kidney donor transplants if they had potential donors (46.8% versus 60.3%). Compared with those younger than 40 years of age, transplant candidates 60 years of age and older were less likely to receive living donor kidney transplants (15.1% versus 43.2%), recruit potential living donors (34.0% versus 64.6%), and receive living donor kidney transplants if they had potential donors (44.5% versus 66.8%). “Barriers at both these steps in the living donor process contribute to the lower rates of living donor kidney transplant among African American or older patients,” said Dr. Weng.