title: Racial-ethnic disparities in mortality and kidney transplant outcomes among pediatric dialysis patients.
abstract: Previous studies in adult hemodialysis patients have shown that African-American and Hispanic patients have a lower risk of mortality in addition to a lower likelihood of kidney transplantation. However, studies of the association between race and outcomes in pediatric dialysis are sparse and often do not examine outcomes in Hispanic children. The objective was to determine if racial-ethnic disparities in mortality and kidney transplantation outcomes exist in pediatric dialysis patients.
  
  
  
  This was a retrospective cohort analysis of 2,697 pediatric dialysis patients (aged 0-20 years) from a large national dialysis organization (entry period 2001-2011) of non-Hispanic white, African-American, and Hispanic race-ethnicity. Associations between race-ethnicity with mortality and kidney transplantation outcomes were examined separately using competing risks methods. Logistic regression analyses were used to examine the association between race-ethnicity, with outcomes within 1 year of dialysis initiation.
  
  
  
  Of the 2,697 pediatric patients in this cohort, 895 were African-American, 778 were Hispanic, and 1,024 were non-Hispanic white. After adjusting for baseline demographics, competing risk survival analysis revealed that compared with non-Hispanic whites, African-Americans had a 64 % higher mortality risk (hazards ratio [HR] = 1.64; 95 % CI 1.24-2.17), whereas Hispanics had a 31 % lower mortality risk (HR = 0.69; 95 % CI 0.47-1.01) that did not reach statistical significance. African-Americans also had higher odds of 1-year mortality after starting dialysis (odds ratio [OR] = 2.08; 95 % CI 0.95-4.58), whereas both African-Americans and Hispanics had a lower odds of receiving a transplant within 1 year of starting dialysis (OR = 0.28; 95 % CI 0.19-0.41 and OR = 0.43; 95 % CI 0.31-0.59 respectively).
  
  
  
  In contrast to adults, African-American pediatric dialysis patients have worse survival than their non-Hispanic white counterparts, whereas Hispanics have a similar to lower mortality risk. Both African-American and Hispanic pediatric dialysis patients had a lower likelihood of kidney transplantation than non-Hispanic whites, similar to observations in the adult dialysis population.
authors: David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors: Marciana
authors: M
authors: Laster
authors: Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, School of Medicine, University of California Irvine, 101 The City Drive South, City Tower, Suite 400, ZOT: 4088, Orange, CA, 92868-3217, USA.
authors: Melissa
authors: M
authors: Soohoo
authors: Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
authors: Clinton
authors: C
authors: Hall
authors: Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, School of Medicine, University of California Irvine, 101 The City Drive South, City Tower, Suite 400, ZOT: 4088, Orange, CA, 92868-3217, USA.
authors: Elani
authors: E
authors: Streja
authors: Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, School of Medicine, University of California Irvine, 101 The City Drive South, City Tower, Suite 400, ZOT: 4088, Orange, CA, 92868-3217, USA.|Division of Nephrology and Hypertension, School of Medicine, University of California Irvine, Orange, CA, USA.
authors: Connie M
authors: CM
authors: Rhee
authors: Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, School of Medicine, University of California Irvine, 101 The City Drive South, City Tower, Suite 400, ZOT: 4088, Orange, CA, 92868-3217, USA.
authors: Vanessa A
authors: VA
authors: Ravel
authors: Division of Nephrology and Hypertension, School of Medicine, University of California Irvine, Orange, CA, USA.
authors: Uttam
authors: U
authors: Reddy
authors: David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors: Keith C
authors: KC
authors: Norris
authors: David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors: Isidro B
authors: IB
authors: Salusky
authors: David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. kkz@uci.edu.|Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, School of Medicine, University of California Irvine, 101 The City Drive South, City Tower, Suite 400, ZOT: 4088, Orange, CA, 92868-3217, USA. kkz@uci.edu.|Division of Nephrology and Hypertension, School of Medicine, University of California Irvine, Orange, CA, USA. kkz@uci.edu.
authors: Kamyar
authors: K
authors: Kalantar-Zadeh
mesh_terms: D000293:Adolescent; D001741:Black or African American; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005006:Ethnicity; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000601:surgery; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D044469:Racial Groups; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People; D055815:Young Adult
keywords: African–American; Dialysis; End-stage renal disease; Ethnicity; Hispanic; Mortality; Pediatric; Race; Transplant