Kidney transplantation is the best treatment for kidney failure. In the United States, Hispanic/Latinos and American Indians experience lower rates of kidney transplantation than non-Hispanic Whites. Despite similar referral rates to non-Hispanic Whites, both Hispanic/Latinos and American Indians are less likely to be wait-listed or to undergo kidney transplantation. Completing the kidney transplant evaluation process is an essential step in gaining access to transplantation, and this period provides a critical opportunity to implement approaches that reduce transplant disparities among patients. Patients face long wait times to see specialists and challenges with coordinating and attending the multiple appointments required to complete evaluation. CHEK-D is conducting a study, Access to Kidney Transplantation in Minority Populations (AKT-MP), to address these issues.
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The Access to Kidney Transplantation in Minority Populations (AKT-MP) Trial compares two patient-centered methods to enhance evaluation: fast track, a concierge-based coordinated care approach; versus peer navigators, former UNM transplant recipients who have been trained in motivational interviewing. This pragmatic randomized trial will use a comparative effectiveness approach to assess whether fast track or peer navigators can help patients complete transplant evaluation.
English- and Spanish-speaking patients will be recruited for the trial. After a baseline interview, we will randomly assign patients to the two groups. Fast track participants will receive expedited appointment scheduling services through a coordinated scheduling protocol established between the research team and respective clinics. Peer navigator participants will meet once per month with their navigator and receive individualized support on navigating the evaluation process. We will track patient progress through electronic medical record review, and contact them for follow-up interviews after they complete transplant evaluation, regardless of whether they are waitlisted or not. We will re-contact all patients who receive a kidney transplant one-year post-transplant (regardless of transplant date).
In addition to baseline and post-intervention questionnaires to assess patient-reported outcomes, we will use the Consolidated Framework for Implementation Research (CFIR) approach to conduct in-depth interviews with patients, navigators, clinical and research staff. Also, we will collect geospatial data regarding patients’ environment and other structural social drivers of health. The results of this trial will provide key information for facilitating the evaluation process, improving patient care, and decreasing disparities in kidney transplantation.
This project is made possible by:
Dr. Larissa Myaskovsky is the Principal Investigator of AKT-MP. She is a Professor in the Department of Internal Medicine at the University of New Mexico, School of Medicine. Also, she is the Director of the Center for Healthcare Equity in Kidney Disease (CHEK-D) and the Director of Faculty Research Development in the Office of Research, UNM Health Sciences. Dr. Myaskovsky’s collaborators include investigators from UNM and a variety of other institutions.
Dr. Mark Unruh, Co-Investigator - University of New Mexico. He is a Professor and Chair of the Department of Internal Medicine at the University of New Mexico, School of Medicine.
Dr. Pooja Singh, Co-Investigator - University of New Mexico. She is an Associate Professor in the Department of Internal Medicine at the University of New Mexico, School of Medicine.
Dr. Yiliang Zhu, Co-Investigator - University of New Mexico. He is a Professor in the Department of Internal Medicine and Interim Division Chief of Epidemiology, Biostatistics and Preventive Medicine at the University of New Mexico, School of Medicine.
Dr. Sarah Erickson, Co-Investigator - University of New Mexico. She is an Associate Professor in the Department of Psychology at the University of New Mexico.
Dr. Jamie Loor, Co-Investigator - University of New Mexico. She is a Consultant on the AKT-MP project and a clinical psychologist in private practice.
Dr. Ashwini Sehgal, Co-Investigator - Case Western Reserve University. He is a Professor in the Departments of Medicine, Bioethics, and Population and Quantitative Health Sciences in the School of Medicine, and the Director and Duncan Neuhauser Professor of Community Health Improvement, Center for Reducing Health Disparities.
Dr. Cindy Bryce, Co-Investigator - University of Pittsburgh. She is an Associate Dean for Enrollment, and Director, MPH and JD/MPH Programs, Health Policy and Management, School of Public Health.
Dr. Sarah Goff, Co-Investigator - University of Massachusetts, Amherst. She is a Professor of Health Policy and Management and Chair, Department of Health Promotion and Policy in the School of Public Health and Health Sciences.
Since initiating the project in 2020, we have published and presented the following scientific work:
Loor JM, Judd N, Rice CM, Perea DD, Croswell EJ, Singh P, Unruh M, Zhu Y, Sehgal A, Goff S, Bryce C, Myaskovsky L. Protocol for the AKT-MP Trial: Access to Kidney Transplantation in Minority Populations. Contemporary Clinical Trials Communications. 2022-12-01, Volume 30, Article 101015; PMID: 36246997; PMCID: PMC9562954; DOI: 10.1016/j.conctc.2022.101015.
Adler Jaffe S, Velez-Bermudez M, Perea D, Jamharian C, Leyva Y, Sok N, Zhu Y, Singh P, Unruh M, Myaskovsky L, “Jumping into Action to Enhance Kidney Transplant Evaluation: Update on the Access to Kidney Transplant in Minority Populations (AKT-MP) Trial.” Poster presented at UNM Family and Community Medicine Scholar’s Day. Albuquerque, NM, June, 2024.
Arteaga Leon A, Adler Jaffe S, Velez-Bermudez M, Jamharian C, Pacheco R, Leyva Y , Sok N, Zhu Y, Singh P, Unruh M, Myaskovsky L. "Engaging with Spanish-Speaking Patients About Kidney Transplantation: The Access to Kidney Transplant in Minority Populations (AKT-MP) Trial." Poster presented at UNM Community of Scholars Fall Research Day. Albuquerque, NM. October 2024
Arteaga Leon A, Adler Jaffe S, Velez-Bermudez M, Jamharian C, Pacheco R, Leyva Y , Sok N, Zhu Y, Singh P, Unruh M, Myaskovsky L. "Engaging with Spanish-Speaking Patients About Kidney Transplantation: The Access to Kidney Transplant in Minority Populations (AKT-MP) Trial." Poster presented at New Mexico Society of Health-System Pharmacists Fall Symposium. Albuquerque, NM. November 2024
Patient-Facing Newsletters: Each Fall and Spring, the study team develops a multi-page newsletter for distribution to all participants, peer navigators and Co-Investigators. The newsletter is distributed in both English and Spanish. The full color newsletter is mailed to each participant and also distributed to other interested parties via email.