Racial Differences in Choice of Dialysis Modality for Children With End-stage Renal Disease

Furth, Susan L.; Powe, Neil R.; Hwang, Wenke; Neu, Alicia M.; Fivush, Barbara A.

doi:10.1542/peds.99.4.e6

Cited by 21 publications

(12 citation statements)

References 23 publications

(27 reference statements)

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“…4,19–21 However, our study results are in contrast with an analysis of adults with CKD in the REGARDS (Reasons for Geographic And Racial Differences in Stroke)) study which found that household income was independently associated with GFR. 22 The present study did not find statistically significant differences by income in the decline of kidney function in these children and adolescents.…”

Section: Discussioncontrasting

confidence: 99%

Association of Income Level With Kidney Disease Severity and Progression Among Children and Adolescents With CKD: A Report From the Chronic Kidney Disease in Children (CKiD) Study

Hidalgo

Moxey-Mims

et al. 2013

American Journal of Kidney Diseases

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Background Among adults, lower socioeconomic status (SES) is a risk factor for chronic kidney disease (CKD), progression to end stage renal disease, and poor health outcomes, but the effect among young people with CKD is not well known. Study Design Prospective cohort study. Settings & Participants 572 children and adolescents aged 1 to 16 years with mild to moderate CKD residing in the United States and Canada who were enrolled in the Chronic Kidney Disease in Children (CKiD) Study, a multicenter prospective cohort. Predictor Self-reported annual household income category as a proxy measure for SES: ≥$75,000 (high income), $30,000 to <$75,000 (middle income) and<$30,000 (low income). Outcomes & Measurements Clinical characteristics and CKD severity at baseline (GFR; comorbidities related to disease severity and management) and longitudinally (GFR decline; changes in blood pressure z scores and height z scores per year). Results At baseline, low and middle household incomes, compared to high income, were associated with minority race (39% and 20% vs. 7%), lower maternal education (28% and 5% vs. 1%), abnormal birth history (34% and 32% vs. 21%), and having at least one clinical comorbidity (66% and 64% vs. 55%).Baseline median GFRs were similar across income categories(between 43 and 45 ml/min/1.73m2). After adjusting for baseline differences, the average GFR declines per year for the high, middle and low income categories were −1.9%, −2.7%, and −2.3%, respectively, and were not statistically significantly different between groups. Blood pressure control tended to improve in all groups (z score, between −0.10 and −0.04), but this was not associated with income. Height deficits diminished over time for subjects from high income families but not among subjects from low income families(z scores for height per year, 0.05 and −0.004, respectively; P = 0.03 for comparison of high and low income). Limitations Statistical power to detect associations by income level is limited; income is an imperfect measure for SES; CKiD participants are not representative of children and adolescents with CKD who are uninsured or not receiving care. Conclusions GFR decline and blood pressure control were comparable across income groups. Children and adolescents with CKD from lower income households are at higher risk of impaired growth.

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Section: Discussioncontrasting

confidence: 99%

Association of Income Level With Kidney Disease Severity and Progression Among Children and Adolescents With CKD: A Report From the Chronic Kidney Disease in Children (CKiD) Study

Hidalgo

Moxey-Mims

et al. 2013

American Journal of Kidney Diseases

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“…This phenomenon has been reported for adults and children with all causes of ESRD in the U.S. in recent years; the rate of hemodialysis initiation among African Americans rather than peritoneal dialysis is nearly four times that reported for whites 31 . A study of children enrolled in the USRDS in 2000 found that African American race was strongly associated with the use of hemodialysis, speculating that family, patient, or provider preferences could account for the racial difference in choice of therapy 46 .…”

Section: Discussionmentioning

confidence: 99%

End-stage renal disease due to lupus nephritis among children in the US, 1995-2006

Hiraki¹,

Lü²,

Alexander³

et al. 2011

Arthritis & Rheumatism

104

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Purpose Little is known about the sociodemographic correlates of kidney transplantation and survival among U.S. children with lupus nephritis-associated ESRD. We aimed to identify predictors of listing for kidney transplantation (wait-listing), kidney transplantation, and mortality among children with lupus nephritis-associated ESRD. Methods Children aged 5–18 years with new onset lupus nephritis-associated ESRD were identified in the U.S. Renal Data System (1995–2006). We investigated demographic and clinical characteristics, causes of death and predictors of wait-listing, kidney transplantation, and mortality during the first 5 years of ESRD. Cox proportional hazards models were used. Results 583 children had incident lupus nephritis-associated ESRD. Mean age at ESRD onset was 16.2 years (SD 2.4); 51% were African American and 24% Hispanic. Within 5 years 292 (49%) were wait-listed, 193 (33%) received a kidney transplant and 131 (22%) died. Main causes of death were cardiopulmonary (31%) and infectious (16%). Children in the Northeast and West (vs. South) were more than twice as likely to be wait-listed (P<0.001, P<0.001) and over 50% more likely to be transplanted (P<0.04). There were fewer kidney transplants among older vs. younger (OR 0.59, P=0.009), African American vs. white (OR 0.48, P<0.001), Hispanic vs. non-Hispanic (OR 0.63, P=0.03) children, and those with Medicaid vs. private insurance (OR 0.7, P=0.03). Mortality was almost double among African American vs. white children (OR 1.83, P<0.001). Conclusions Among U.S. children with lupus nephritis-associated ESRD age, race, ethnicity, insurance and geographic region were associated with significant variation in 5-year wait-listing for kidney transplant, kidney transplantation and mortality.

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“…Furth et al found more use of HD instead of PD in children of African American descent. Family, patient, and provider preferences all accounted for the difference in choice of therapy by race [14]. In addition, they suggest that systematic racial bias specifically may have contributed to the difference in dialysis modality choice.…”

Section: Discussionmentioning

confidence: 99%

Disparities in dialysis treatment and outcomes for Dutch and Belgian children with immigrant parents

et al. 2012

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BackgroundIn Belgium and the Netherlands, up to 40% of the children on dialysis are children with immigrant parents of non-Western European origin (non-Western). Concerns exist regarding whether these non-Western patients receive the same quality of care as children with parents of Western European origin (Western). We compared initial dialysis, post-initial treatment, and outcomes between non-Western and Western patients on dialysis.MethodsAll children <19 years old on chronic dialysis in the Netherlands and Belgium between September 2007 and May 2011 were included in the study. Non-Western patients were defined as children of whom one or both parents were born in non-Western countries.ResultsSeventy-nine of the 179 included patients (44%) were non-Western children. Compared to Western patients, non-Western patients more often were treated with hemodialysis (HD) instead of peritoneal dialysis (PD) as first dialysis mode (52 vs. 37%, p = 0.046). Before renal transplantation, non-Western patients were on dialysis for a median (range) of 30 (5–99) months, vs. 15 (0–66) months in Western patients (p = 0.007). Renal osteodystrophy was diagnosed in 34% of non-Western vs. 18% of Western patients (p = 0.028). The incidence rate ratio [95% confidence interval] for acute peritonitis was 2.44 [1.43-4.17] (p = 0.032) for non-Western compared to Western patients.ConclusionsThere are important disparities between children on chronic dialysis with parents from Western European origin and those from non-Western European origin in the choice of modality, duration, and outcomes of dialysis therapy.

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Racial Differences in Choice of Dialysis Modality for Children With End-stage Renal Disease

Cited by 21 publications

References 23 publications

Association of Income Level With Kidney Disease Severity and Progression Among Children and Adolescents With CKD: A Report From the Chronic Kidney Disease in Children (CKiD) Study

Association of Income Level With Kidney Disease Severity and Progression Among Children and Adolescents With CKD: A Report From the Chronic Kidney Disease in Children (CKiD) Study

End-stage renal disease due to lupus nephritis among children in the US, 1995-2006

Disparities in dialysis treatment and outcomes for Dutch and Belgian children with immigrant parents

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