Disparities in Care of Patients With End-Stage Renal Disease Review of Literature and Action Plan

Disparities in access to care for patients with end-stage renal disease (ESRD) and particularly to kidney transplantation, as well as discrepancies in follow-up and outcomes have been extensively documented as they relate to race, ethnicity, gender, socioeconomic factors, urban/rural residence, and geographic region. Furthermore, these inequalities seem to be increasing in various parts of the world and it is imperative to develop policies to address them among various population groups, identifying factors that might provide improved care for all patients with kidney disease. Numerous studies from various parts of the world have demonstrated racial, ethnic, and geographic differences regarding the delivery of healthcare to patients with ESRD. To the author’s knowledge, although this issue has been studied at transplant centers in Iran on an individual basis, it has not been extensively studied on a national scale. In this paper, the current world literature will be reviewed, with the goal of emphasizing the need to initiate and expand full-scale studies to detect and remedy any existing inequalities in Iran, a vast country with an ethnically, culturally, and economically diverse population. The author proposes the designation, at the national level, of a task force to study disparities and to provide insight into the means of correcting them. As Iran continues to attain a position of regional leadership in the realm of organ transplantation, it seems prudent to invest in research aimed at detecting and remedying any inequalities in the provision of equivalent and just care for patients with ESRD.