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Abstract: TH-PO369

Factors Affecting Initial Dialysis Modality in Pediatric ESRD

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Brunson, Celina, The Children''s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Shults, Justine, Perelman School of Medicine University of Pennsylvania, Philadellphia, Pennsylvania, United States
  • Amaral, Sandra, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
Background

Children from minority and immigrant backgrounds are more likely to be placed on hemodialysis (HD) vs. peritoneal dialysis (PD) at onset of end stage renal disease (ESRD).We hypothesize that social determinants of health (SDOH), beyond the effect of race/ethnicity, influence initial dialysis modality.

Methods

We performed a retrospective cohort study of children 1-18 years who started dialysis between 2000-2012 using the US Renal Data System database. Using national census and American community survey data based on the patient’s residence zip code, we derived a community level health risk score comprised of 17 items representing the five elements of SDOH defined by Healthy People 2020. (Table 1) Used a multivariable logistic regression model to identify associations between dialysis modality (HD vs. PD) and the health risk score, adjusting for age at incident ESRD, race, sex and ESRD cause.

Results

Among 5,607 patients, 3,472 (61.9%) had HD as their initial modality vs. 2,135 (31.8%) who were started on PD. Patients in the lower quintile for risk score (more favorable community based on the included variables) were more likely to be placed on PD (OR 1.456, p-value 0.000, 95%CI 1.21-1.75) vs those in the highest quintile of risk score (OR 1.267, p-value 0.014, 95% CI 1.049-1.53) when adjusting for age at incident ESRD, race, sex and ESRD cause. In this multivariable model, race was not associated with initial dialysis modality.

Conclusion

Children with highest risk scores were less likely to be placed on PD vs patients in neighborhoods with lower risk. Race was not associated in our model with initial dialysis modality unlike earlier studies looking at similar associations. Our findings suggest that it may be informative to examine SDOH along with race when examining inequities in health care access. Next steps will include differential weighting of variables within the risk score to determine whether there are modifiable factors that impact initial dialysis modality for children.

Variables of Health risk score

Funding

  • NIDDK Support