International Urology and Nephrology

, Volume 44, Issue 3, pp 945–954 | Cite as

Roma ethnicity and clinical outcomes in kidney transplant recipients

  • Miklos Z. Molnar
  • Robert M. Langer
  • Adam Remport
  • Maria E. Czira
  • Katalin Rajczy
  • Kamyar Kalantar-Zadeh
  • Csaba P. Kovesdy
  • Marta Novak
  • Istvan Mucsi
  • Laszlo Rosivall
Nephrology - Original Paper

Abstract

Background

Racial and ethnic disparities among North American patients with chronic kidney disease have received significant attention. In contrast, little is known about health-related outcomes of patients with end-stage renal disease among the Roma minority, also known as gypsies, compared to Caucasian individuals. We prospectively assessed the association between Roma ethnicity and long-term clinical outcomes in kidney transplant recipients.

Methods

In a prevalent cohort of renal transplant recipients, followed up over a median of 94 months, we prospectively collected socio-demographic, medical (and transplant related) characteristics and laboratory data at baseline from 60 Roma and 1,003 Caucasian patients (mean age 45 (SD = 11) and 49 (SD = 13) years, 33 and 41% women, 18 and 17% with diabetes mellitus, respectively). Survival analyses examined the associations between Roma ethnicity and all-cause mortality and death-censored graft loss or death with functioning renal allograft.

Results:

During the follow-up period, 341 patients (32%) died. Two-hundred eighty (26%) patients died with a functioning graft and 201 patients (19%) returned to dialysis. After multivariable adjustments, Roma ethnicity was associated with 77% higher risk of all-cause mortality (Hazard Ratio (HR): 1.77; 95% confidence interval (CI): 1.02, 3.07), two times higher risk of mortality with functioning graft (2.04 [1.17–3.55]) and 77% higher risk of graft loss (1.77 [1.01–3.13]), respectively.

Conclusions

Roma ethnicity is independently associated with increased mortality risk and worse graft outcome in kidney transplant recipients. Further studies should identify the factors contributing to worse outcomes among Roma patients.

Keywords

Roma ethnicity Kidney transplantation Mortality, graft loss 

Notes

Acknowledgments

This study was supported by grants from the National Research Fund (OTKA) (KTIA-OTKA-EU 7KP-HUMAN-MB08-A-81231), ETT (206/09), the Hungarian Kidney Foundation, Hungarian Society of Hypertension, Hungarian Society of Nephrology and the Foundation for Prevention in Medicine. MZM received grants from the National Developmental Agency (KTIA-OTKA-EU 7KP-HUMAN-MB08-A-81231) from the Research and Technological Innovation Fund, was also supported by Hungarian Kidney Foundation. The research of M. Novak has been supported by the János Bolyai Research Scholarship of the Hungarian Academy of Sciences (2008–2011) and the Center for Integrative Mood Research, Toronto, Canada.

Conflict of interest

None.

Supplementary material

11255_2011_88_MOESM1_ESM.doc (34 kb)
Supplementary material 1 (DOC 34 kb)

References

  1. 1.
    Norris KC, Agodoa LY (2005) Unraveling the racial disparities associated with kidney disease. Kidney Int 68:914–924PubMedCrossRefGoogle Scholar
  2. 2.
    Agodoa L (2002) Racial disparities in kidney health: the puzzle to solve. Am J Kidney Dis 40:1337–1339PubMedCrossRefGoogle Scholar
  3. 3.
    Agodoa L, Eggers P (2007) Racial and ethnic disparities in end-stage kidney failure-survival paradoxes in African-Americans. Semin Dial 20:577–585PubMedCrossRefGoogle Scholar
  4. 4.
    United States Renal Data System (2007) United States renal data system 2006 annual data report atlas of chronic kidney disease & end-stage renal disease in the United States. Am J Kidney Dis 49:1–296CrossRefGoogle Scholar
  5. 5.
    United States Renal Data System (2006) Excerpts from the USRDS 2005 annual data report: atlas of end-stage renal disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Am J Kid Dis 47(Suppl 1):1–286Google Scholar
  6. 6.
    Kalantar-Zadeh K, Kovesdy CP, Derose SF et al (2007) Racial and survival paradoxes in chronic kidney disease. Nat Clin Pract Nephrol 3:493–506PubMedCrossRefGoogle Scholar
  7. 7.
    Kovesdy CP, Anderson JE, Derose SF et al (2009) Outcomes associated with race in males with nondialysis-dependent chronic kidney disease. Clin J Am Soc Nephrol 4:973–978PubMedCrossRefGoogle Scholar
  8. 8.
    Fraser A (1995) Gypsies (Peoples of Europe), 2nd edn. Blackwell, OxfordGoogle Scholar
  9. 9.
    Hancock I (2002) Ame Sam e Rromane Džene/We are the Romani people. In: Hertfordshire (ed) University of Hertfordshire Press, vol 13Google Scholar
  10. 10.
    Roma and Travellers/Statistics Council of Europe Accessed at http://www.coe.int/t/dg3/romatravellers/Source/documents/stats.xls
  11. 11.
    Kenrick D (1971) The World Romani Congress—April 1971. J Gypsy Lore Soc 50:101–108Google Scholar
  12. 12.
    Hancock I (2004) Romanies and the holocaust: a reevaluation and an overview. In: The historiography of the Holocaust. Palgrave-Macmillan, New YorkGoogle Scholar
  13. 13.
  14. 14.
    Thomas JD, Doucette MM, Thomas DC et al (1987) Disease, lifestyle, and consanguinity in 58 American Gypsies. Lancet 2:377–379PubMedCrossRefGoogle Scholar
  15. 15.
    Dolinska S, Kudlackova M, Ginter E (2007) The prevalence of female obesity in the world and in the Slovak Gypsy women. Bratislavske lekarske listy 108:207–211PubMedGoogle Scholar
  16. 16.
    Zeljko H, Skaric-Juric T, Narancic NS et al (2008) Traditional CVD risk factors and socio-economic deprivation in Roma minority population of Croatia. Coll Antropol 32:667–676PubMedGoogle Scholar
  17. 17.
    Vozarova de Courten B, de Courten M, Hanson RL et al (2003) Higher prevalence of type 2 diabetes, metabolic syndrome and cardiovascular diseases in gypsies than in non-gypsies in Slovakia. Diabetes Res Clin Pract 62:95–103PubMedCrossRefGoogle Scholar
  18. 18.
    Ramal LM, Lopez-Nevot MA, Sabio JM et al (2004) Systemic lupus erythematosus in southern Spain: a comparative clinical and genetic study between Caucasian and Gypsy patients. Lupus 13:934–940PubMedCrossRefGoogle Scholar
  19. 19.
    Langer RM, Hidvegi M, Jaray J (2005) Significant differences in the efficacy of kidney transplantation between Hungarian Caucasians and Gypsies. Transpl Proc 37:729–730CrossRefGoogle Scholar
  20. 20.
    Molnar-Varga M, Molnar MZ, Szeifert L et al (2011) Health related quality of life and clinical outcomes in kidney transplanted recipients. Am J Kidney Dis 58:444–452PubMedCrossRefGoogle Scholar
  21. 21.
    Mucsi I, Molnar MZ, Ambrus C et al (2005) Restless legs syndrome, insomnia and quality of life in patients on maintenance dialysis. Nephrol Dial Transpl 20:571–577CrossRefGoogle Scholar
  22. 22.
    Molnar MZ, Szentkiralyi A, Lindner A et al (2007) High prevalence of patients with a high risk for obstructive sleep apnoea syndrome after kidney transplantation–association with declining renal function. Nephrol Dial Transpl 22:2686–2692CrossRefGoogle Scholar
  23. 23.
    Molnar MZ, Novak M, Szeifert L et al (2007) Restless legs syndrome, insomnia, and quality of life after renal transplantation. J Psychosom Res 63:591–597PubMedCrossRefGoogle Scholar
  24. 24.
    Molnar MZ, Novak M, Ambrus C et al (2005) Restless legs syndrome in patients after renal transplantation. Am J Kidney Dis 45:388–396PubMedCrossRefGoogle Scholar
  25. 25.
    Novak M, Molnar MZ, Ambrus C et al (2006) Chronic insomnia in kidney transplant recipients. Am J Kidney Dis 47:655–665PubMedCrossRefGoogle Scholar
  26. 26.
    Levey A, Greene T, Kusek J et al (2000) A simplified equation to predict glomerular filtration rate from serum creatinine {Abstract}. J Am Soc Nephrol 11:155AGoogle Scholar
  27. 27.
    Mucsi I, Kovacs AZ, Molnar MZ et al (2008) Co-morbidity and quality of life in chronic kidney disease patients. J Nephrol 21(Suppl 13):S84–S91PubMedGoogle Scholar
  28. 28.
    Molnar MZ, Szentkiralyi A, Lindner A et al (2007) Restless legs syndrome and mortality in kidney transplant recipients. Am J Kidney Dis 50:813–820PubMedCrossRefGoogle Scholar
  29. 29.
    Molnar MZ, Czira M, Ambrus C et al (2007) Anemia is associated with mortality in kidney-transplanted patients–a prospective cohort study. Am J Transpl 7:818–824CrossRefGoogle Scholar
  30. 30.
    Fine JP, Gray RJ (1999) A proportional hazards model for the subdistribution of competing risk. J Am Stat Assoc 94:496–509Google Scholar
  31. 31.
    Szeifert L, Molnar MZ, Ambrus C et al (2010) Symptoms of depression in kidney transplant recipients: a cross-sectional study. Am J Kidney Dis 55:132–140PubMedCrossRefGoogle Scholar
  32. 32.
    Butler JA, Peveler RC, Roderick P et al (2004) Modifiable risk factors for non-adherence to immunosuppressants in renal transplant recipients: a cross-sectional study. Nephrol Dial Transpl 19:3144–3149CrossRefGoogle Scholar
  33. 33.
    Pinsky BW, Takemoto SK, Lentine KL et al (2009) Transplant outcomes and economic costs associated with patient noncompliance to immunosuppression. Am J Transpl 9:2597–2606CrossRefGoogle Scholar
  34. 34.
    Novak M, Molnar MZ, Szeifert L et al (2010) Depressive symptoms and mortality in patients after kidney transplantation: a prospective prevalent cohort study. Psychosom Med 72:527–534PubMedCrossRefGoogle Scholar
  35. 35.
    Voko Z, Csepe P, Nemeth R et al (2009) Does socioeconomic status fully mediate the effect of ethnicity on the health of Roma people in Hungary? J Epidemiol Community Health 63:455–460PubMedCrossRefGoogle Scholar
  36. 36.
    Simko V, Ginter E (2010) Short life expectancy and metabolic syndrome in Romanies (gypsies) in Slovakia. Cent Eur J Public Health 18:16–18PubMedGoogle Scholar
  37. 37.
    Fernandez O, Fernandez V, Martinez-Cabrera V et al (2008) Multiple sclerosis in Gypsies from southern Spain: prevalence, mitochondrial DNA haplogroups and HLA class II association. Tissue Antigens 71:426–433PubMedCrossRefGoogle Scholar
  38. 38.
    Zou Y, Stastny P, Susal C et al (2007) Antibodies against MICA antigens and kidney-transplant rejection. N Engl J Med 357:1293–1300PubMedCrossRefGoogle Scholar
  39. 39.
    Sipeky C, Lakner L, Szabo M et al (2009) Interethnic differences of CYP2C9 alleles in healthy Hungarian and Roma population samples: relationship to worldwide allelic frequencies. Blood Cells Mol Dis 43:239–242PubMedCrossRefGoogle Scholar
  40. 40.
    Meier-Kriesche HU, Li S, Gruessner RW et al (2006) Immunosuppression: evolution in practice and trends, 1994–2004. Am J Transpl 6:1111–1131CrossRefGoogle Scholar
  41. 41.
    Chang SH, Russ GR, Chadban SJ et al (2007) Trends in kidney transplantation in Australia and New Zealand, 1993–2004. Transplantation 84:611–618PubMedCrossRefGoogle Scholar
  42. 42.
    Craven J, Littlefield C, Rodin G et al (1991) The endstage renal disease severity index (ESRD-SI). Psychol Med 21:237–243PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2011

Authors and Affiliations

  • Miklos Z. Molnar
    • 1
    • 2
    • 3
  • Robert M. Langer
    • 4
  • Adam Remport
    • 5
  • Maria E. Czira
    • 2
  • Katalin Rajczy
    • 6
  • Kamyar Kalantar-Zadeh
    • 3
    • 7
  • Csaba P. Kovesdy
    • 8
    • 9
  • Marta Novak
    • 2
    • 10
  • Istvan Mucsi
    • 1
    • 2
    • 11
  • Laszlo Rosivall
    • 1
  1. 1.Institute of PathophysiologySemmelweis UniversityBudapestHungary
  2. 2.Institute of Behavioral SciencesSemmelweis UniversityBudapestHungary
  3. 3.Harold Simmons Center for Chronic Disease Research and EpidemiologyLos Angeles Biomedical Research Institute at Harbor-UCLATorranceUSA
  4. 4.Department of Transplantation and SurgerySemmelweis UniversityBudapestHungary
  5. 5.Division of NephrologySzent Imre HospitalBudapestHungary
  6. 6.Hungarian National Blood Transfusion ServicerBudapestHungary
  7. 7.UCLA David Geffen School of MedicineLos AngelesUSA
  8. 8.Division of NephrologySalem VA Medical CenterSalemUSA
  9. 9.Division of NephrologyUniversity of VirginiaCharlottesvilleUSA
  10. 10.Department of PsychiatryUniversity Health Network, University of TorontoTorontoCanada
  11. 11.Division of Nephrology, Department of MedicineMcGill University Health CenterMontrealCanada

Personalised recommendations