Treatment Of Kidney Failure Research Articles

Glycemic Variability and KIM-1-Induced Inflammation in the Diabetic Kidney.

Diabetes, the “other pandemic,” has progressively increased in magnitude despite advances in knowledge about diabetes prevention over the last two decades (1). Therefore, diabetes will remain a major public health problem for the foreseeable future. More patients with diabetic complications inevitably accompany more people living with diabetes. Diabetic kidney disease (DKD) is one of the most serious, risky, and common, occurring in ∼30% of patients with type 1 diabetes and ∼40% of those with type 2 diabetes (2). Progressive DKD is now the foremost cause of kidney failure worldwide, accounting for half of all cases (3). However, in many regions, treatment for kidney failure by dialysis or transplantation is inaccessible and DKD becomes an unescapable death sentence. Indeed, DKD is now the most common cause of death in Mexico City (4). However, even such sobering observations fail to capture the true magnitude of the impact, as DKD independently increases risks of all-cause and cardiovascular mortality by more than fivefold even before patients develop kidney failure (5). Indeed, the mortality rate outpaces the rate of progression to kidney failure by more than 2:1 once macroalbuminuria develops (6). The need to find better ways to identify and treat DKD has never been more urgent. Recent therapeutic advances with the sodium–glucose cotransporter 2 inhibitors demonstrate clear benefits on top of the standard of care, yet substantial residual risk of kidney failure and death remains (7,8). Uncovering the biological basis of disease is essential to further therapeutic advancement. While hyperglycemia is a well-recognized DKD risk factor, the traditional biomarker of glycated hemoglobin is an average …

Introduction to Kidney Transplantation: Long-Term Management Challenges.

Kidney transplantation is the optimal treatment for kidney failure, associated with a lower risk of mortality compared with dialysis ([1][1]) and improved quality of life ([2][2]). The number of kidney transplants in the United States continues to increase on an annual basis; 23,401 kidney

Preferences for and Experiences of Shared and Informed Decision Making Among Patients Choosing Kidney Replacement Therapies in Nephrology Care

Rationale & ObjectiveChronic kidney disease (CKD) can progress rapidly, and patients are often unprepared to make kidney failure treatment decisions. We aimed to better understand patients’ preferences for and experiences of shared and informed decision making (SDM) regarding kidney replacement therapy before kidney failure.Study DesignCross-sectional study.Setting & ParticipantsAdults receiving nephrology care at CKD clinics in rural Pennsylvania.PredictorsEstimated glomerular filtration rate, 2-year risk for kidney failure, duration and frequency of nephrology care, and preference for SDM.OutcomesOccurrence and extent of kidney replacement therapy discussions and participants’ satisfaction with those discussions.Analytic ApproachMultivariable logistic regression to quantify associations between participants’ characteristics and whether they had discussions.ResultsThe 447 study participants had a median age of 72 (IQR, 64-80) years and mean estimated glomerular filtration rate of 33 (SD, 12) mL/min/1.73 m2. Most (96%) were White, high school educated (67%), and retired (65%). Most (72%) participants preferred a shared approach to kidney treatment decision making, and only 35% discussed dialysis or transplantation with their kidney teams. Participants who had discussions (n = 158) were often completely satisfied (63%) but infrequently discussed potential treatment-related impacts on their lives. In multivariable analyses, those with a high risk for kidney failure within 2 years (OR, 3.24 [95% CI, 1.72-6.11]; P < 0.01), longer-term nephrology care (OR, 1.12 [95% CI, 1.05-1.20] per 1 additional year; P < 0.01), and more nephrology visits in the prior 2 years (OR, 1.34 [95% CI, 1.20-1.51] per 1 additional visit; P < 0.01) had higher odds of having discussed dialysis or transplantation.LimitationsSingle health system study.ConclusionsMost patients preferred sharing CKD treatment decisions with their providers, but treatment discussions were infrequent and often did not address key treatment impacts. Longitudinal nephrology care and frequent visits may help ensure that patients have optimal SDM experiences.

Renal staffs' understanding of patients' experiences of transition from peritoneal dialysis to in-centre haemodialysis and their views on service improvement: A multi-site qualitative study in England and Australia.

Many studies have explored patients' experiences of dialysis and other treatments for kidney failure. This is the first qualitative multi-site international study of how staff perceive the process of a patient's transition from peritoneal dialysis to in-centre haemodialysis. Current literature suggests that transitions are poorly coordinated and may result in increased patient morbidity and mortality. This study aimed to understand staff perspectives of transition and to identify areas where clinical practice could be improved. Sixty-one participants (24 UK and 37 Australia), representing a cross-section of kidney care staff, took part in seven focus groups and sixteen interviews. Data were analysed inductively and findings were synthesised across the two countries. For staff, good clinical practice included: effective communication with patients, well planned care pathways and continuity of care. However, staff felt that how they communicated with patients about the treatment journey could be improved. Staff worried they inadvertently made patients fear haemodialysis when trying to explain to them why going onto peritoneal dialysis first is a good option. Despite staff efforts to make transitions smooth, good continuity of care between modalities was only reported in some of the Australian hospitals where, unlike the UK, patients kept the same consultant. Timely access to an appropriate service, such as a psychologist or social worker, was not always available when staff felt it would be beneficial for the patient. Staff were aware of a disparity in access to kidney care and other healthcare professional services between some patient groups, especially those living in remote areas. This was often put down to the lack of funding and capacity within each hospital. This research found that continuity of care between modalities was valued by staff but did not always happen. It also highlighted a number of areas for consideration when developing ways to improve care and provide appropriate support to patients as they transition from peritoneal dialysis to in-centre haemodialysis.

Why Is the GFR So High?: Implications for the Treatment of Kidney Failure.

The high GFR in vertebrates obligates large energy expenditure. Homer Smith's teleologic argument that this high GFR was needed to excrete water as vertebrates evolved in dilute seas is outdated. The GFR is proportional to the metabolic rate among vertebrate species and higher in warm-blooded mammals and birds than in cold-blooded fish, amphibians, and reptiles. The kidney clearance of some solutes is raised above the GFR by tubular secretion, and we presume secretion evolved to eliminate particularly toxic compounds. In this regard, high GFRs may provide a fluid stream into which toxic solutes can be readily secreted. Alternatively, the high GFR may be required to clear solutes that are too large or too varied to be secreted, especially bioactive small proteins and peptides. These considerations have potentially important implications for the understanding and treatment of kidney failure.

Application of Advanced Nanomaterials for Kidney Failure Treatment and Regeneration.

The implementation of nanomedicine not only provides enhanced drug solubility and reduced off-target adverse effects, but also offers novel theranostic approaches in clinical practice. The increasing number of studies on the application of nanomaterials in kidney therapies has provided hope in a more efficient strategy for the treatment of renal diseases. The combination of biotechnology, material science and nanotechnology has rapidly gained momentum in the realm of therapeutic medicine. The establishment of the bedrock of this emerging field has been initiated and an exponential progress is observed which might significantly improve the quality of human life. In this context, several approaches based on nanomaterials have been applied in the treatment and regeneration of renal tissue. The presented review article in detail describes novel strategies for renal failure treatment with the use of various nanomaterials (including carbon nanotubes, nanofibrous membranes), mesenchymal stem cells-derived nanovesicles, and nanomaterial-based adsorbents and membranes that are used in wearable blood purification systems and synthetic kidneys.

Kidney-Related Research in the United States: A Position Statement From the National Kidney Foundation and the American Society of Nephrology

Kidney disease is an important US public health problem because it affects over 37 million Americans, and Medicare expenditures for patients with chronic kidney disease now alone exceed $130 billion annually. Kidney disease is characterized by strong racial, ethnic, and socioeconomic disparities, and reducing kidney disease incidence will positively impact US health disparities. Due to the aging of the US population and an unabated obesity epidemic, the number of patients receiving treatment for kidney failure is anticipated to increase, which will escalate kidney disease health expenditures. The historical and current investment in kidney-related research via the National Institute of Diabetes and Digestive and Kidney Diseases has severely lagged behind ongoing expenditures for kidney disease care. Increasing research investment will identify, develop, and increase implementation of interventions to slow kidney disease progression, reduce incidence of kidney failure, enhance survival, and improve quality of life. This perspective states the urgent reasons why increasing investment in kidney-related research is important for US public health. The National Kidney Foundation and the American Society of Nephrology are working together to advocate for increased funding for the National Institute of Diabetes and Digestive and Kidney Diseases. The long-term goal is to reduce the burden of kidney disease in the US population and improve the quality of life of patients living with kidney disease.

Barriers to pre-emptive kidney transplantation in New Zealand children.

Pre-emptive kidney transplantation (PKT) is generally considered the optimal treatment for kidney failure as it minimises dialysis-associated morbidity and mortality and is associated with improved allograft survival. This study aimed to determine rates of paediatric PKT in New Zealand, identify barriers to PKT and consider potential interventions to influence future rates of pre-emptive transplantation. Children commencing kidney replacement therapy between 2005 and 2017 in New Zealand were included. Descriptive analysis considered those referred late (referral <3months prior to kidney replacement therapy initiation) or early based on referral timing to paediatric nephrology. Additional analysis compared characteristics of children receiving dialysis versus pre-emptive transplant as their first mode of kidney replacement therapy. PKT occurred in 15 of 90 children (17%). One-third of all patients were referred late. No late referrals received a pre-emptive transplant. Pre-emptively transplanted children were referred younger (median age 0.49 years), lived in less deprived areas, were more likely to have congenital anomalies of the kidney and urinary tract and none were Māori or Pasifika ethnicity. Late referral, higher deprivation levels and Māori and Pasifika ethnicity confer a greater risk of not receiving pre-emptive transplantation. Improved education amongst health professionals about recognition of paediatric chronic kidney disease and the importance of timely referral to paediatric nephrology is recommended to reduce rates of late referral. A modified approach including enhanced culturally appropriate support for those diagnosed with chronic kidney disease during transplant evaluation should be pursued to improve equity.

Patient Education for Kidney Failure Treatment: A Mixed-Methods Study

Education programs are needed for people with advanced chronic kidney disease to understand kidney failure treatment options and participate in shared decision-making (SDM). Little is known about the content and accessibility of current education programs or whether they support SDM. Stakeholder-engaged, mixed-methods design incorporating qualitative observations and interviews, and a quantitative content analysis of slide presentations. Four sites located in Boston, Chicago, Portland (Maine), and San Diego. Thematic analysis based on the Ottawa Framework (observations and interviews) and descriptive statistical analysis (slide presentations). Data were collected from observations of 9 education sessions, 5 semistructured interviews with educators, and 133 educational slide presentations. Sites offered group classes or one-on-one sessions. Development, quality, and accuracy of educational materials varied widely. Educators emphasized dialysis (often in-center hemodialysis), with little mention of conservative management. Educators reported patients were often referred too late to education sessions and that some patients become overwhelmed if they learn of the implications of kidney failure in a group setting. Commonly, sessions were general and did not provide opportunities for tailored information most supportive of SDM. Few nephrologists were involved in education sessions or aware of the educational content. Content gaps included prognosis, decision support, mental health and cognition, advance care planning, cost, and diet. Slide presentations used did not consistently reflect best practices related to health literacy. Findings may not be broadly generalizable. Education sessions focused on kidney failure treatment options do not consistently follow best practices related to health literacy or for supporting SDM. To facilitate SDM, the establishment of expectations for kidney failure treatment options should be clearly defined and integrated into the clinical workflow. Addressing content gaps, health literacy, and communication with nephrologists is necessary to improve patient education in the setting of advanced chronic kidney disease.

Personalized physical rehabilitation program and employment in kidney transplant recipients: a randomized trial.

Kidney transplantation is the preferred treatment for kidney failure; however after transplant, reduced physical function, poor self-perceptions, and unemployment are common concerns that remain. This randomized controlled trial compared the effects of a 12-month exercise rehabilitation program (intervention) to standard care alone (control) in kidney transplant recipients. The exercise intervention consisted of a 2day/week, 60-minute personalized, one-on-one, resistance-based exercise trainings. Eighty participants completed the study (52 intervention vs. 28 control). For individuals unemployed at baseline, there was a 52.3% increase in employment compared to 13.3 % increase in the control group after 12months (P=<0.0001). For those already employed at baseline, 100% of individuals maintained employment in both groups after 12months (P=0.4742). For all comers, there was a positive trend for Global Physical Health (P=0.0034), Global Mental Health (P=0.0064), and Physical Function (P=0.0075), with the intervention group showing greater improvements. These findings suggest the implementation of an exercise rehabilitation program postkidney transplant can be beneficial to increase employment for individuals previously unemployed, improve self-perceived health, physical function, and mental health, overall contributing to better health outcomes in kidney transplant recipients. (Clinicaltrials.gov number: NCT02409901).

POS-539 PREVIOUS SELF-CARE KIDNEY FAILURE TREATMENT AND HOME HEMODIALYSIS TRAINING LENGTH

Optimal training is of utmost importance for successful home hemodialysis (HHD) and a key component of its cost-effectiveness. Training pattern varies depending of patient-, center- and modality-related factors. This study aimed to evaluate predictors of training duration, postulating that previous peritoneal dialysis (PD) patients and kidney transplant recipient (KTR) may have shorter HHD training duration. All successfully trained HHD patients from a single academic dialysis center between January 2005 and July 2017 were included. Training duration was evaluated, from the first training session to the first independent home treatment, in a multivariable linear regression, with pre-specified adjustment for previous self-care kidney failure treatment (defined as kidney transplantation and/or PD exposure), demographic (age, sex), diabetes and year of training start. Forty-eight patients were included in this study. Of them, 17 (35%) had previous self-care kidney failure treatment including 8 (17%) with PD, 3 (6%) KTR and 6 (13%) having both previous PD and KTR. Median training time was 10.8 (8.7-13.0) weeks in patients with previous self-care treatment and 13.7 (10.7-18.9) weeks in patients without. There were no statistically significant differences in baseline characteristics, with the exception of kidney failure duration, which was longer in patients with previous self-care treatment (6.7 years, interquartile range [IQR] 3.0-13.1) than those without (0.9 years, IQR 0.30-1.76; p<0.001). In a multivariable adjusted linear regression, previous self-care kidney failure treatment was the only statistically significant predictor of shorter training duration (B coefficient -4.8, 95% CI -8.7; -0.89; p=0.02). Tabled 1VariablesB Coefficient95% Confidence Intervalp-valuePrevious self-care kidney failure-4.8-8.7; -0.90.02Age at training start, per 10 years-0.7-2.3; 1.00.42Male-2.4-6.6; 1.80.25Diabetes2.2-2.3; 6.60.33Most recent era (2014-2017 vs. 2005-2013)2.0-2.2; 5.90.35 Open table in a new tab In this study, previous self-care kidney failure treatment was associated with shorter HHD training. This study enhances the need to maximize independent kidney failure therapy transitions, such as suggested in the Integrated home dialysis model.

Overview of Various Components of the Science of Patient Input: Advancing the Use of Patient-Reported, Real-World Evidence for Medical Device Evaluation of Innovative Products for the Treatment of Kidney Failure Using Strategically Coordinated Registry Networks.

In the United States, 746,557 individuals live with ESKD, with approximately 70% receiving dialysis ([1][1]). Dialysis, although life sustaining, is a life-changing therapy for patients. In a survey of patients with CKD on dialysis, 51.9% of patients reported that their decision to be treated with

Protection From the Second Warm Ischemic Injury in Kidney Transplantation Using an Ex Vivo Porcine Model and Thermally Insulating Jackets

BackgroundKidney transplantation is the optimum treatment for kidney failure in carefully selected patients. Technical surgical complications and second warm ischemic time (SWIT) increase the risk of delayed graft function (DGF) and subsequent short- and long-term graft outcomes including the need for post-transplant dialysis and graft failure. Intraoperative organ thermal regulation could reduce SWIT, minimizing surgical complications due to time pressure, and limiting graft ischemia-reperfusion injury. MethodsA novel ischemic-injury thermal protection jacket (iiPJ) was designed and fabricated in silicone composite and polyurethane (PU) elastomer prototypes. Both were compared with no thermal insulation as controls. Time to reach ischemic threshold (15°C) and thermal energy transfer were compared. A water bath model was used to examine the thermal protective properties of porcine kidneys, as a feasibility study prior to in vivo translation. ResultsIn both iterations of the iiPJ, the time taken to reach the warm ischemia threshold was 35.2 ± 1.4 minutes (silicone) and 38.4 ± 3.1 minutes (PU), compared with 17.2 ± 1.5 minutes for controls (n = 5, P < .001 for both comparisons). Thermal energy transfer was also found to be significantly less for both iiPJ variants compared with controls. There was no significant difference between the thermal performance of the 2 iiPJ variants. ConclusionProtection from SWIT by using a protective insulation jacket is feasible. With clinical translation, this novel strategy could facilitate more optimal surgical performance and reduce transplanted organ ischemia-reperfusion injury, in particular the SWIT, potentially affecting delayed graft function and long-term outcomes.

Symptom burden and health-related quality of life in hemodialysis patients

Health-Related Quality of Life (HRQOL) is a substantial outcome of the treatment of kidney failure. Hemodialysis patients report a tremendous symptom burden which appears to be associated with HRQOL. This study aimed to identify symptom burden and the association between symptom burden and HRQOL. This study used a cross-sectional design. One hundred hemodialysis patients completed the modified Edmonton Symptom Assessment System (ESAS) and Kidney Dialysis Quality of Life Short Form (KDQOL-SF). The mean of the total modified ESAS scores was 12.6 (SD=6.27) and the overall HRQOL score was 54.74 (SD=5.62). There was a correlation between symptom burden and HRQOL scores (r=-0.244; p<0.05). The symptom burden in the hemodialysis patients was significant and had a negative correlation with the overall HRQOL. This study provides data for institutional programs to reduce symptom burden and improve the quality of life in hemodialysis patients.

Encapsulation of Activated Carbon into a Hollow-Type Spherical Bacterial Cellulose Gel and Its Indole-Adsorption Ability Aimed at Kidney Failure Treatment.

For reducing side effects and improvement of swallowing, we studied the encapsulation of activated carbon formulations with a hollow-type spherical bacterial cellulose (HSBC) gel using two kinds of encapsulating methods: Methods A and B. In Method A, the BC gelatinous membrane was biosynthesized using Komagataeibacter xylinus (K. xylinus) at the interface between the silicone oil and cell suspension containing activated carbon. In Method B, the bacterial cellulose (BC) gelatinous membrane was formed at the interface between the cell suspension attached to the alginate gel containing activated carbon and the silicone oil. After the BC gelatinous membrane was biosynthesized by K. xylnus, alginate gel was removed by soaking in a phosphate buffer. The activated carbon encapsulated these methods could neither pass through the BC gelatinous membrane of the HSBC gel nor leak from the interior cavity of the HSBC gel. The adsorption ability was evaluated using indole, which is a precursor of the uremic causative agent. From curve-fitting, the adsorption process followed the pseudo-first-order and intra-particle diffusion models, and the diffusion of the indole molecules at the surface of the encapsulated activated carbon within the HSBC gel was dominant at the initial stage of adsorption. It was observed that the adsorption of the encapsulated activated carbon by the intraparticle diffusion process became dominant with longer adsorption times.

Cost-Utility of Dialysis in Canada: Hemodialysis, Peritoneal Dialysis, and Nondialysis Treatment of Kidney Failure

Rationale & ObjectiveThe kidney failure population is growing, necessitating the expansion of dialysis programs. These programs are costly and require a substantial amount of health care resources. Tools that accurately forecast resource use can aid efficient allocation. The objective of this study is to describe the development of an economic simulation model that incorporates treatment history and detailed modality transitions for patients with kidney disease using real-world data to estimate associated costs, utility, and survival by initiating modality.Study DesignCost-utility model with microsimulation.Setting & PopulationAdult incident maintenance dialysis patients in Canada who initiated facility-based hemodialysis (HD) or home peritoneal dialysis (PD) between 2004 and 2013.InterventionHD and PD.OutcomesCosts (related to dialysis, transplantation, infections, and hospitalizations), survival, utility, and dialysis modality mix over time.Model, Perspective, & TimeframeThe model took the perspective of the health care payer. Patients were followed up for 10 years from initiation of dialysis. Our cost-utility analysis compared the intervention with receiving no treatment.ResultsDuring a 10-year time horizon, the cost-utility ratio for all patients initiating dialysis was $103,779 per quality-adjusted life-year (QALY) in comparison to no treatment. Patients who initiated with facility-based HD were treated at a cost-utility ratio of $104,880/QALY and patients who initiated with home PD were treated at a cost-utility ratio of $83,762/QALY. During this time horizon, the total mean cost and QALYs per patient were estimated at $350,774 ± $204,704 and 3.38 ± 2.05) QALYs respectively.LimitationsThe results do not include costs from the societal perspective. Rare patient trajectories were unable to be assessed.ConclusionsThis model demonstrates that patients who initiated dialysis with PD were treated more cost-effectively than those who initiated with HD during a 10-year time horizon.

Hubungan Nilai Trombosit dan Hematokrit dengan Kegagalan Arteriovenous Fistula pada Pasien Gagal Ginjal

Hemodialysis is a treatment for kidney failure that uses a machine to send the patient's blood through a filter. Arteriovenous fistulas (AVF) and arteriovenous grafts are vascular access that is designed for long-term use. In the world, the number of patients with end-stage chronic kidney failure (CRF) which requires hemodialysis is increasing. However, almost 50% of arteriovenous fistulas can never be used for hemodialysis, and if they can be used, 25% will experience failure after 2 years. Many factors make the AVF failure, between the injury of the endothelial wall or the hypercoagulation. This study uses a cross-sectional retrospective design. Data is taken from the medical record status of patients with chronic kidney failure in RSUP Dr. M.Djamil Padang from January 2017-December 2019. Data were analyzed by Chi-square and Fisher test. From a sample of 33 people, patients obtained hematocrit values &lt;33%, 33-36%,&gt; 36% failure of AVF as many as 8, 2, and 4 people. While the platelet values &lt;150,000,150,000-400,000 and 400,000 obtained AVF failures were 0.9 and 5 people. There was no relationship of platelet values with AVF failure in hemodialysis patients with p-value=0,323. There was a correlation between hematocrit values and AVF failure in hemodialysis patients with p-value=0,003.

Challenges and novel therapies for vascular access in haemodialysis.

Advances in standards of care have extended the life expectancy of patients with kidney failure. However, options for chronic vascular access for haemodialysis - an essential part of kidney replacement therapy - have remained unchanged for decades. The high morbidity and mortality associated with current vascular access complications highlights an unmet clinical need for novel techniques in vascular access and is driving innovation in vascular access care. The development of devices, biological approaches and novel access techniques has led to new approaches to controlling fistula geometry and manipulating the underlying cellular and molecular pathways of the vascular endothelium, and influencing fistula maturation and formation through the use of external mechanical methods. Innovations in arteriovenous graft materials range from small modifications to the graft lumen to the creation of completely novel bioengineered grafts. Steps have even been taken to create new devices for the treatment of patients with central vein stenosis. However, these emerging therapies face difficult hurdles, and truly creative approaches to vascular access need resources that include well-designed clinical trials, frequent interaction with regulators, interventionalist education and sufficient funding. In addition, the heterogeneity of patients with kidney failure suggests it is unlikely that a 'one-size-fits-all' approach for effective vascular access will be feasible in the current environment.

The current and future landscape of dialysis.

The development of dialysis by early pioneers such as Willem Kolff and Belding Scribner set in motion several dramatic changes in the epidemiology, economics and ethical frameworks for the treatment of kidney failure. However, despite a rapid expansion in the provision of dialysis — particularly haemodialysis and most notably in high-income countries (HICs) — the rate of true patient-centred innovation has slowed. Current trends are particularly concerning from a global perspective: current costs are not sustainable, even for HICs, and globally, most people who develop kidney failure forego treatment, resulting in millions of deaths every year. Thus, there is an urgent need to develop new approaches and dialysis modalities that are cost-effective, accessible and offer improved patient outcomes. Nephrology researchers are increasingly engaging with patients to determine their priorities for meaningful outcomes that should be used to measure progress. The overarching message from this engagement is that while patients value longevity, reducing symptom burden and achieving maximal functional and social rehabilitation are prioritized more highly. In response, patients, payors, regulators and health-care systems are increasingly demanding improved value, which can only come about through true patient-centred innovation that supports high-quality, high-value care. Substantial efforts are now underway to support requisite transformative changes. These efforts need to be catalysed, promoted and fostered through international collaboration and harmonization.

P1635INVESTIGATING REASONS FOR ETHNIC INEQUITY IN LIVING-DONOR KIDNEY TRANSPLANTATION IN THE UK: A MIXED METHODS ANALYSIS OF A MULTICENTRE QUESTIONNAIRE-BASED STUDY

Abstract Background and Aims A living-donor kidney transplant (LDKT) is one of the best treatments for kidney failure, yet in the UK there is evidence of ethnic inequity in access. We designed this questionnaire-based mixed-methods study to investigate the patient-reported reasons that family members of Black, Asian and Minority Ethnic group (BAME) individuals were not able to become living kidney donors. Method This questionnaire-based case-control study included 14 UK hospitals. Participants were adults transplanted between 1/4/13-31/3/17. Participants provided data on all relatives aged &amp;gt;18 years who could have been potential living kidney donors. Participants were asked for the reasons why relatives could not donate: individuals were asked to tick all options that applied from a list of reasons (Age; Health; Weight; Location; Financial/Cost; Job; Blood group; No-one to care for them after donation), and a box was provided for free-text entries following the option of ‘Other – please give details’. Multivariable logistic regression was used to analyse the association between the likelihood of selecting each reason for non-donation and the participant’s ethnicity (binary variable White versus BAME). 56/171 BAME respondents provided free text responses and all were analysed. Qualitative responses were analysed using thematic analysis. Results 1,240 questionnaires were returned from 3,103 patients (40% response). There was strong evidence that after adjustment for potential confounders sex, age and socioeconomic position, BAME individuals were more likely than White respondents to indicate that family members lived too far away to donate (adjusted odds ratio (aOR) 3.14 [95% CI 2.10-4.70]), were prevented from donating by financial concerns (aOR 2.25 [95% CI 1.49-3.39]), were not able to take time off work (aOR 2.05 [95% CI 1.36-3.09]), and were not the right blood group (aOR 1.47 [95% CI 1.12-1.94]). Four qualitative themes were identified from free-text responses from BAME participants: i) Burden of disease within the family ii) ‘Unorthodox’ religious beliefs iii) Specific geographical concerns (healthcare provision, visa difficulties) iv) Knowledge handling. The theme ‘Knowledge Handling’ incorporated three subthemes: a) Need for more detailed knowledge, b) Protected disclosure of health status, and c) Recipient assumptions about potential donor knowledge. Conclusion We have identified multiple barriers to living kidney donation in the UK BAME population, which should be further investigated and addressed. BAME transplant recipients were more likely to report that potential donors were not the right blood group to donate: work should be undertaken to ascertain if this reflects true ABO-incompatibility or perceived incompatibility. Potential donors living outside the UK is a major barrier, related to difficulties with accessing visa and concerns about a specific country’s healthcare system’s capacity for longer-term post-donation care. The financial barriers reported may disproportionately affect overseas donors who, although entitled to reimbursement for travel, accommodation and visa costs, may incur large “up-front” costs which may be prohibitive. No respondents reported that a major religion’s position on living donation was a barrier to donation. However, there were several references to family members holding beliefs that were described as ‘distorted’ religious beliefs: this highlights the need to understand the beliefs of potential donors who belong to non-mainstream religions, which may be out of the remit of denominational faith leaders.