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Kidney Week

Abstract: SA-PO368

Racial Differences in Outcomes in Children on Maintenance Dialysis Enrolled in the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS)

Session Information

  • Pediatric Nephrology - III
    November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology

Authors

  • Altemose, Kathleen, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Daga, Ankana, Harvard Medical School, Boston, Massachusetts, United States
  • Boynton, Sara Ashley, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Neu, Alicia, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Somers, Michael J., Harvard Medical School, Boston, Massachusetts, United States
Background

The NAPRTCS dialysis registry includes 8923 children from the last 30 years. We aim to describe racial differences in this cohort.

Methods

Children on maintenance dialysis at a NAPRTCS center are enrollment eligible. Demographic and clinical data are obtained at dialysis initiation and every 6-months until dialysis terminates. Before 2018 race was categorized as white, black or Hispanic, but race (white, black, other) and ethnicity are now separate. Outcomes include dialysis modality, cardiovascular health, time to transplant and survival.

Results

Table 1 shows clinical characteristics at dialysis initiation. There were more white than black children on both peritoneal dialysis (PD) and hemodialysis (HD), although a higher % of blacks were on HD. Those initiating HD with catheter access were more likely white than black (43% vs 29%); no racial difference with AV fistulas (36% white and 36% black). Mean Kt/V and URR were higher for non-black than black race on HD (1.61 vs 1.55, and 72.6 vs 70.7), with similar findings for PD mean Kt/V (2.45 non-black vs 2.14 black). More blacks than non-blacks had hypertension (48% vs 35%), left ventricular hypertrophy (32% vs 29%), and hypercholesterolemia (60% vs 20%). Over time, whites were transplanted more than blacks when listed for deceased donor transplants (50% vs 30% at 12 months; 87% vs 75% at 36 months).In those remaining on dialysis, survival was slightly higher for blacks than whites (89% vs 86% at 36 months).

Conclusion

White children have higher rates of kidney developmental anomalies, whereas racial differences are absent with FSGS frequency. Whites receive PD more than non-whites, whereas blacks receive HD at higher rates. Whites are more likely to initiate HD with catheter access. Regardless of modality, blacks demonstrate lower dialysis adequacy and more cardiac health sequelae. Whites are transplanted quicker than blacks. In children remaining on dialysis, 36 month survival is near 90% in both blacks and whites. Further study is needed to understand these disparities and to ensure optimal outcomes for all chronically dialyzed children.