Abstract: SA-OR069
Child Opportunity and Chronic Pediatric Dialysis Outcomes
Session Information
- Innovations in Pediatric Nephrology and Kidney Development
November 08, 2025 | Location: Room 371A, Convention Center
Abstract Time: 05:20 PM - 05:30 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Daga, Ankana, Boston Children's Hospital, Boston, Massachusetts, United States
- Ciccia, Eileen Anna, Washington University in St Louis, St. Louis, Missouri, United States
- Grills, Natalie K, Children's Hospital Association, Overland Park, Kansas, United States
- McDermott, Katherine M, Johns Hopkins Medicine, Baltimore, Maryland, United States
- Boynton, Sara Ashley, Johns Hopkins University, Baltimore, Maryland, United States
- Dutta, Sreejata, Children's Hospital Association, Overland Park, Kansas, United States
- Richardson, Troy, Children's Hospital Association, Overland Park, Kansas, United States
- Somers, Michael J., Boston Children's Hospital, Boston, Massachusetts, United States
Background
The Child Opportunity Index (COI) quantifies neighborhood-level educational, environmental, and socioeconomic opportunity, identifying areas where low opportunity may drive health disparities. While disparities in pediatric kidney disease outcomes are well documented, the association of area-level opportunity with chronic dialysis outcomes in children remains underexplored.
Methods
We conducted a retrospective cohort study of patients (<21 years) in the North American Pediatric Renal Trials and Collaborative Studies registry who initiated chronic dialysis at a Pediatric Health Information System (PHIS) hospital from 2012 to 2023. Registry linkage was achieved using a probabilistic three-step matching process. Patients were grouped by COI quintiles (based on PHIS zip codes) into low (very low/low) and high (moderate/high/very high) categories.
Results
A total of 1,125 patients were studied. Age at dialysis initiation, sex distribution, and primary renal diagnosis did not differ significantly between COI categories. Race and ethnicity varied significantly (p<0.001) with Non-Hispanic White patients were more commonly in the high vs. low category (53.7% vs. 38.2%), while Non-Hispanic Black (26.4% vs. 12.2%) and Hispanic (30.4% vs. 19.6%) patients were more frequently in the low COI category. Public insurance use was higher in the low COI category (71.1% vs 46.2%, p<0.001).
Overall, dialysis initiation declined over time (520 in 2012–2017 to 436 in 2018–2023), with an increasing proportion of high COI category in the later cohort (p<0.001). Median time to transplant was shorter in the high COI category vs low category (14 vs. 18 months, p<0.001). Peritoneal dialysis was more frequent in the high COI category, while the low COI category was more likely to have had a prior dialysis course (57.1% vs. 46.8%, p=0.003) and live further from their hospital (35 vs. 21 miles, p=0.009). Growth outcomes were not significantly different (z-score −1.84 vs. −1.56, p=0.099). Rates of prior kidney transplant and comorbid complex chronic conditions were similar between groups.
Conclusion
Neighborhood-level opportunity is associated with disparities in pediatric dialysis care and outcomes. These findings highlight the need for further research to understand relationships between opportunity and outcomes to mitigate disparities.
Funding
- Private Foundation Support