Racial and Ethnic Disparities in Renal Replacement Therapy in Pediatric and Young Adult Population with End Stage Renal Disease (2005-2015).
1Pediatric Nephrology, Emory University, Atlanta, GA
2Dept of Surgery, Emory University, Atlanta, GA
3Dept of Surgery, Duke University, Durham, NC
4USRDS Rehabilitation, QoL Special Studies Center, Atlanta, GA
5Dept of Epidemiology, Rollins School of Public Health, Atlanta, GA
Meeting: 2017 American Transplant Congress
Abstract number: D167
Keywords: Hispanic, Kidney transplantation, Outcome, Pediatric
Session Information
Date: Tuesday, May 2, 2017
Session Name: Poster Session D: Kidney: Pediatric
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall D1
In the last decade, few studies have examined racial/ethnic disparities in the choice of renal replacement therapy (RRT) among children with End Stage Renal Disease (ESRD). Previous studies have noted that blacks are more likely to receive hemodialysis (HD) than peritoneal dialysis (PD) or preemptive transplant (pTx); however, these studies did not examine ethnic differences, compare all forms of RRT or adjust for receipt of pre-ESRD nephrology care.
Design: A retrospective cross-sectional analysis of patients < 21 years, was done using United States Renal Data System data from 10/1/2005-6/1/2015. Generalized logit models were used to calculate odds ratios (OR) and 95% confidence intervals (CI) of modality choice by race and ethnicity. We adjusted for differences in age, sex, socioeconomic status (SES), Organ Procurement Organization region and pre-ESRD nephrology care.
Results: Among 12,173 patients initiating RRT, 44.6% were white (non-Hispanic), 29.1% black, and 26.3% Hispanic. 54.8% patients received HD, 29.7% PD and 15.5% pTx. Compared to whites, blacks were less likely to receive pTx (OR=0.19; 95% CI: 0.16-0.22) or PD (OR=0.49; 95% CI: 0.44-0.54). Hispanics were also less likely to undergo pTx (OR=0.36; 95% CI: 0.31-0.41) or PD (OR=0.72; 95% CI: 0.66-0.79) compared to whites. More whites (71.7%) received pre-ESRD nephrology care compared to Hispanics (59.5%) or blacks (65.2%) (p< 0.0001). After adjusting for demographic, clinical, and socioeconomic differences, including pre-ESRD nephrology care, disparities were attenuated among Hispanics for PD (OR=0.89; 95% CI 0.79-1.00), but not for pTx (OR=0.51; 95% CI 0.43-0.59). In adjusted analysis, both pTx (OR=0.30; 95% CI: 0.25-0.36) and PD (OR=0.62; 95% CI: 0.54-0.70) were lower for blacks vs. whites.
Conclusion: Blacks and Hispanics are less likely to receive pTx or PD compared to whites. Access to health care, SES and demographic factors may explain some of this disparity for Hispanics, but not for blacks. Unmeasured differences in SES, comorbidities, familial/physician preferences may also contribute to these differences.
CITATION INFORMATION: George R, Basu M, Greenbaum L, Kirk A, Kutner N, Patzer R. Racial and Ethnic Disparities in Renal Replacement Therapy in Pediatric and Young Adult Population with End Stage Renal Disease (2005-2015). Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
George R, Basu M, Greenbaum L, Kirk A, Kutner N, Patzer R. Racial and Ethnic Disparities in Renal Replacement Therapy in Pediatric and Young Adult Population with End Stage Renal Disease (2005-2015). [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/racial-and-ethnic-disparities-in-renal-replacement-therapy-in-pediatric-and-young-adult-population-with-end-stage-renal-disease-2005-2015/. Accessed October 19, 2019.« Back to 2017 American Transplant Congress