Racial variation in cardiovascular disease risk factors among European children on renal replacement therapy-results from the European Society for Paediatric Nephrology/European Renal Association - European Dialysis and Transplant Association Registry.
BACKGROUND
Racial differences in overall mortality rates have been found in children on renal replacement therapy (RRT). We used data from the European Society for Paediatric Nephrology/European Renal Association - European Dialysis and Transplant Association Registry to study racial variation in the prevalence of cardiovascular disease (CVD) risk factors among European children on RRT.


METHODS
We included patients aged <20 years between 2006-13 who (i) initiated dialysis treatment or (ii) had a renal transplant vintage of ≥1 year. Racial groups were defined as white, black, Asian and other. The CVD risk factors assessed included uncontrolled hypertension, obesity, hyperphosphataemia and anaemia. Differences between racial groups in CVD risk factors were examined using generalized estimating equation (GEE) models while adjusting for potential confounders.


RESULTS
In this study, 1161 patients on dialysis and 1663 patients with a transplant were included. The majority of patients in both groups were white (73.8% and 79.9%, respectively). The crude prevalence of the CVD risk factors was similar across racial groups. However, after adjustment for potential confounders, Asian background was associated with higher risk of uncontrolled hypertension both in the dialysis group [odds ratio (OR): 1.27; 95% confidence interval (CI): 1.01-1.64] and the transplant group (OR: 1.37; 95% CI: 1.11-1.68) compared with white patients. Patients of Asian and other racial background with a renal transplant had a higher risk of anaemia compared with white patients (OR: 1.50; 95% CI: 1.15-1.96 and OR: 1.45; 95% CI: 1.01-2.07, respectively). Finally, the mean number of CVD risk factors among dialysis patients was higher in Asian patients (1.83, 95% CI: 1.64-2.04) compared with white patients (1.52, 95% CI: 1.40-1.65).


CONCLUSIONS
We found a higher prevalence of modifiable CVD risk factors in Asian children on RRT. Early identification and management of these risk factors could potentially improve long-term outcomes.
ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands.|Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam, The Netherlands.
Lidwien A
LA
Tjaden
ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands.
Kitty J
KJ
Jager
ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands.
Marjolein
M
Bonthuis
Swiss Pediatric Renal Registry, Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Claudia E
CE
Kuehni
Department of Pediatric Nephrology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
Marc R
MR
Lilien
Department of Pediatrics, University Hospital Motol, Charles University Prague, 2nd Faculty of Medicine, Prague, Czech Republic.
Tomas
T
Seeman
Department of Pediatric Nephrology, 'A. and P. Kyriakou' Children's Hospital, Athens, Greece.
Constantinos J
CJ
Stefanidis
Department of Pediatric Nephrology, Great North Children's Hospital, Newcastle Upon Tyne, UK.
Yincent
Y
Tse
Pediatric Nephrology Unit, Bordeaux University Hospital, Bordeaux, France.
Jérôme
J
Harambat
Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam, The Netherlands.
Jaap W
JW
Groothoff
ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands.
Marlies
M
Noordzij
D000293:Adolescent; D044466:Asian People; D044383:Black People; D002648:Child; D002675:Child, Preschool; D005060:Europe; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D006973:Hypertension / Q000208:ethnology / Q000401:mortality*; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000401:mortality* / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D009765:Obesity / Q000208:ethnology / Q000401:mortality*; D015995:Prevalence; D012042:Registries; D006435:Renal Dialysis; D012307:Risk Factors; D016896:Treatment Outcome; D044465:White People
cardiovascular disease; children; dialysis; ethnicity; kidney transplantation