? Kidney loss in the first 10 years following transplantation remains a significant problem despite tremendous scientific advances in treating acute rejection and immunosuppression. This problem is pressing because racial/ethnic and socioeconomic disparities persist in kidney survival rates causing inequities in graft outcomes. One possible explanation for this survival difference is social inequities in self-care practices of compliance and symptom management. Self-care is essential to the survival of the kidney. But the resources (e.g., financial, social support) for self-care are not equitably distributed in the population. Under the new 2001 Medicare bill (HR 4577), only kidney recipients with disabilities obtain full support for as long as the new kidney functions, but most kidney recipients do not have disabilities, so financial support remains limited. This limitation can lead to the waste of scarce kidneys because it prevents patients from sustaining their kidneys after three years. Consequently, the capacity for and practice of self-care varies by race/ethnicity and insurance status. ? The proposed interdisciplinary study will examine the social, cultural, and economic strategies and resources that kidney recipients mobilize to keep their kidneys healthy in the context of limited financial support from insurers.
The specific aims of this study are to: 1) examine transplant recipients' health beliefs about kidney survival, compliance, and rejection; 2) investigate transplant recipients' practices of self-care and financially maintaining a kidney transplant; 3) measure the impact of recipients' health beliefs and self-care practices on graft outcomes; and 4) compare self-care practices and graft outcomes among kidney recipients with different demographic and socioeconomic backgrounds. ? To accomplish these goals, the proposed four-year longitudinal study will use a multi-method approach for data collection. Data will be gathered prospectively through interviews with kidney recipients every six months and through medical chart review. Identifying the sociocultural and economic processes associated with better graft survival is important for: a) preventing kidney rejection, b) devising compliance interventions, c) preparing candidates for transplant through education, d) evaluating health policies designed to prevent financial barriers to kidney transplantation, and e) eliminating disparities in long-term kidney survival rates ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Scientist Development Award - Research & Training (K01)
Project #
5K01DK063953-06
Application #
7278762
Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Program Officer
Rankin, Tracy L
Project Start
2003-09-30
Project End
2009-08-31
Budget Start
2007-09-01
Budget End
2009-08-31
Support Year
6
Fiscal Year
2007
Total Cost
$116,544
Indirect Cost
Name
Albany Medical College
Department
Type
Schools of Medicine
DUNS #
190592162
City
Albany
State
NY
Country
United States
Zip Code
12208
Gordon, Elisa J; Ladner, Daniela P; Caicedo, Juan Carlos et al. (2010) Disparities in kidney transplant outcomes: a review. Semin Nephrol 30:81-9
Gordon, Elisa J; Prohaska, Thomas R; Gallant, Mary P et al. (2010) Prevalence and determinants of physical activity and fluid intake in kidney transplant recipients. Clin Transplant 24:E69-81
Gordon, E J; Conti, D (2010) The quality of health insurance service delivery for kidney transplant recipients: a patient perspective. Am J Transplant 10:2208-14
Gordon, Elisa J; Prohaska, Thomas R; Gallant, Mary et al. (2009) Self-care strategies and barriers among kidney transplant recipients: a qualitative study. Chronic Illn 5:75-91
Kress, J; Smith, D L; Fehling, P C et al. (2009) Improving the recruitment and retention of organ procurement coordinators: a survey study. Am J Transplant 9:1451-9
Gordon, Elisa J; Wolf, Michael S (2009) Health literacy skills of kidney transplant recipients. Prog Transplant 19:25-34
Gordon, Elisa J; Prohaska, Thomas R; Gallant, Mary P et al. (2009) Longitudinal analysis of physical activity, fluid intake, and graft function among kidney transplant recipients. Transpl Int 22:990-8
McNutt, Louise-Anne; Gordon, Elisa J; Uuskula, Anneli (2009) Informed recruitment in partner studies of HIV transmission: an ethical issue in couples research. BMC Med Ethics 10:14
Devraj, Radhika; Gordon, Elisa J (2009) Health literacy and kidney disease: toward a new line of research. Am J Kidney Dis 53:884-9
Gordon, Elisa J; Caicedo, Juan Carlos (2009) Ethnic advantages in kidney transplant outcomes: the Hispanic Paradox at work? Nephrol Dial Transplant 24:1103-9

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