title: Racial differences in renal replacement therapy initiation among children with a nonglomerular cause of chronic kidney disease.
abstract: African American (AA) adults with chronic kidney disease (CKD) have a faster progression to end-stage renal disease and are less likely to receive a kidney transplant. It is unclear whether AA children experience renal replacement therapy (RRT) for end-stage renal disease sooner than non-AA children after accounting for socioeconomic status (SES).
  
  
  
  Among children with nonglomerular CKD in the Chronic Kidney Disease in Children study, we investigated time to RRT (i.e., first dialysis or transplant) after CKD onset using parametric survival models and accounted for SES differences by inverse probability weights.
  
  
  
  Of 110 AA and 493 non-AA children (median age = 10 years), AA children had shorter time to first RRT: median time was 3.2 years earlier than non-AA children (95% CI: -6.1, -0.3). When accounting for SES, this difference was diminished and nonsignificant (-1.6 years; 95% CI: -4.6, +1.5), and its directionality was consistent with faster glomerular filtration rate decline among AA children (-6.2% vs. -4.4% per year, P = .098). When RRT was deconstructed into dialysis or transplant, the time to dialysis was 37.5% shorter for AA children and 53.7% longer for transplant. These inferences were confirmed by the frequency and timing of transplant after initiating dialysis.
  
  
  
  Racial differences in time to RRT were almost fully accounted for by SES, and the remaining difference was congruent with a faster glomerular filtration rate decline among AA children. Access to transplant occurred later, yet times to dialysis were shorter among AA children even when accounting for SES which may be due to a lack of organ availability.
authors: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Electronic address: dng3@jhu.edu.
authors: Derek K
authors: DK
authors: Ng
authors: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
authors: Marva
authors: M
authors: Moxey-Mims
authors: Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO.
authors: Bradley A
authors: BA
authors: Warady
authors: Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
authors: Susan L
authors: SL
authors: Furth
authors: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors: Alvaro
authors: A
authors: Muñoz
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005500:Follow-Up Studies; D054625:Healthcare Disparities / Q000639:trends*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D044469:Racial Groups; D012016:Reference Values; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality / Q000628:therapy*; D017582:Renal Replacement Therapy / Q000379:methods / Q000706:statistics & numerical data*; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States
keywords: Chronic kidney disease; Health disparities; Inverse probability weights; Pediatric nephrology; Renal replacement therapy