Pediatric Nephrology

, Volume 32, Issue 4, pp 685–695 | Cite as

Racial–ethnic disparities in mortality and kidney transplant outcomes among pediatric dialysis patients

  • Marciana Laster
  • Melissa Soohoo
  • Clinton Hall
  • Elani Streja
  • Connie M. Rhee
  • Vanessa A. Ravel
  • Uttam Reddy
  • Keith C. Norris
  • Isidro B. Salusky
  • Kamyar Kalantar-Zadeh
Original Article



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.


Race 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.

Financial disclosure

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.

Supplementary material

467_2016_3530_MOESM1_ESM.docx (23 kb)
Supplemental Table 1 (DOCX 23 kb)


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Copyright information

© IPNA 2016

Authors and Affiliations

  • Marciana Laster
    • 1
  • Melissa Soohoo
    • 2
  • Clinton Hall
    • 3
  • Elani Streja
    • 2
  • Connie M. Rhee
    • 2
    • 4
  • Vanessa A. Ravel
    • 2
  • Uttam Reddy
    • 4
  • Keith C. Norris
    • 1
  • Isidro B. Salusky
    • 1
  • Kamyar Kalantar-Zadeh
    • 1
    • 2
    • 4
  1. 1.David Geffen School of Medicine at UCLALos AngelesUSA
  2. 2.Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, School of MedicineUniversity of California IrvineOrangeUSA
  3. 3.Department of EpidemiologyUCLA Fielding School of Public HealthLos AngelesUSA
  4. 4.Division of Nephrology and Hypertension, School of MedicineUniversity of California IrvineOrangeUSA

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