I conducted a four-month ethnographic fieldwork study to document the stories of thirteen post-kidney-transplant minority patients and three nephrologists at Boston Medical Center. My research explores how patients’ interactions with health professionals, medical regimens, dialysis treatments, and adaptation to living with transplanted kidneys constantly shape their identities and perceptual worlds. Patients’ narratives highlighted the emotional struggles they encountered along the path of End-Stage Renal Disease, which unfolded as distinct experiences influenced by their varied backgrounds. The majority of my patient-participants lived on the verge of poverty, and in some cases, their insurance status caused delays in their being registered on the transplant waiting list, making them endure a long wait. Some patients were afraid of wearing short sleeves because they thought the scars on their arms from dialysis treatment would lead others to think they were gangsters. Instantiations of various theories emerged from the saturated data and narrative analysis, from Bourdieu’s concept of habitus with regard to the process of how patients alter their consciousness through interactions with medicine to Foucault’s ideas of power relations and technologies of the self that address the issues of agency and power that influence the formation of patients’ identities. The intersection of these theoretical frameworks led me to develop the critical medical anthropological-oriented concept of biological citizenship. This paper examines 1) the ways in which “race” interacts with the theoretical concept of biological citizenship and 2) the ways in which socioeconomic status and race tailor a kidney transplant patient’s illness experience, and related discourse.

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INTRODUCTION: In patients who receive treatment for cancer, acute kidney injury (AKI) is arguably one of the most dangerous toxicities that results from cisplatin (CP), a chemotherapeutic agent. While AKI is a common occurrence amongst people who receive cisplatin (CP-AKI), the current risk assessment, intervention methods and understanding the role of magnesium in AKI, are either limited or understudied. OBJECTIVES: We aimed to build on previous CP-AKI risk prediction models, and establish a relationship between serum magnesium levels and AKI. Additionally, we used a feasibility study to test if intravenous magnesium sulfate in patients receiving intraoperative chemotherapy with cisplatin (HIOCC) for malignant mesothelioma can attenuate CP-AKI. This feasibility study was also used to determine a proper dosing regimen to achieve serum magnesium levels of 3 - 4.8 mg/dl. METHODS: We defined acute kidney injury as a 1.5-fold increase in serum creatine, or use of renal replacement therapy (RRT). Using clinical and demographic information from Memorial Sloan Kettering’s database, we conducted multivariable and univariable regression was used to identify the most significant demographic and clinical lab values. Using the information from the statistical analysis we built on previous risk prediction models for cisplatin associated kidney injury. Using the same statistical analysis, we further explored the relationship between serum magnesium values and AKI. In the feasibility study, we recruited patients from Brigham and Woman’s hospital who were receiving HIOCC treatment for mesothelioma. They received an infusion of intravenous magnesium sulfate during surgery. Serum magnesium levels were measured pre-operatively and post-operatively along with serum creatinine values. These were used to obtain pharmacokinetic information to further adjust the infusion rate in patients, lab values were also used to identify any AKI. CONCLUSION: A score-based model created using patient’s age, serum magnesium, albumin, hemoglobin, platelets, cisplatin dose and hypertension is predictive of cisplatin associated acute kidney injury. The feasibility study allowed us to inform phase 2 of an upcoming feasibility study that will include a bolus of 6g Mg/hr and an infusion of 2 g/hr after the bolus. This will work to increase the serum magnesium levels to the therapeutic range.

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