Racial–ethnic disparities in mortality and kidney transplant outcomes among pediatric dialysis patients
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Previous studies in adult hemodialysis patients have shown that African–American and Hispanic patients have a lower risk of mortality in addition to a lower likelihood of kidney transplantation. However, studies of the association between race and outcomes in pediatric dialysis are sparse and often do not examine outcomes in Hispanic children. The objective was to determine if racial–ethnic disparities in mortality and kidney transplantation outcomes exist in pediatric dialysis patients.
This was a retrospective cohort analysis of 2,697 pediatric dialysis patients (aged 0–20 years) from a large national dialysis organization (entry period 2001–2011) of non-Hispanic white, African–American, and Hispanic race-ethnicity. Associations between race–ethnicity with mortality and kidney transplantation outcomes were examined separately using competing risks methods. Logistic regression analyses were used to examine the association between race–ethnicity, with outcomes within 1 year of dialysis initiation.
Of the 2,697 pediatric patients in this cohort, 895 were African–American, 778 were Hispanic, and 1,024 were non-Hispanic white. After adjusting for baseline demographics, competing risk survival analysis revealed that compared with non-Hispanic whites, African–Americans had a 64 % higher mortality risk (hazards ratio [HR] = 1.64; 95 % CI 1.24–2.17), whereas Hispanics had a 31 % lower mortality risk (HR = 0.69; 95 % CI 0.47–1.01) that did not reach statistical significance. African–Americans also had higher odds of 1-year mortality after starting dialysis (odds ratio [OR] = 2.08; 95 % CI 0.95–4.58), whereas both African–Americans and Hispanics had a lower odds of receiving a transplant within 1 year of starting dialysis (OR = 0.28; 95 % CI 0.19–0.41 and OR = 0.43; 95 % CI 0.31–0.59 respectively).
In contrast to adults, African–American pediatric dialysis patients have worse survival than their non-Hispanic white counterparts, whereas Hispanics have a similar to lower mortality risk. Both African–American and Hispanic pediatric dialysis patients had a lower likelihood of kidney transplantation than non-Hispanic whites, similar to observations in the adult dialysis population.
KeywordsRace Ethnicity African–American Hispanic Pediatric End-stage renal disease Dialysis Mortality Transplant
KKZ had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Compliance with ethical standards
The study was approved by the Institutional Review Committees of the Los Angeles Biomedical Research Institute at Harbor-UCLA, University of California Irvine, and University of Washington. Given the anonymity of the patients studied and non-intrusive nature of the research, the study was exempt from the requirement for consent.
The work in this manuscript has been performed with the support of the National Institute of Diabetes, Digestive and Kidney Disease of the National Institute of Health research grants R01-DK95668 (KKZ), K24-DK091419 (KKZ), R01-DK078106 (KKZ), and T32-DK104687 (ML). KKZ is supported by philanthropic grants from Mr Harold Simmons, Mr Louis Chang, Mr Joseph Lee and AVEO. CMR is supported by the National Institute of Diabetes, Digestive and Kidney Disease of the National Institute of Health grant K23-DK102903.
Conflicts of interest
KKZ has received honoraria and/or support from Abbott, Abbvie, Alexion, Amgen, American Society of Nephrology, Astra-Zeneca, AVEO, Chugai, DaVita, Fresenius, Genetech, Haymarket Media, Hospira, Kabi, Keryx, National Institutes of Health, National Kidney Foundation, Relypsa, Resverlogix, Sanofi, Shire, Vifor, and ZS-Pharma.
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