Two Studies Find that Racial Inequalities Exist for Children with Kidney Disease

November 2011

"Preemptive Renal Transplantation among the Pediatric ESRD Population," presented at the American Society of Nephrology's Annual Kidney Week from November 8-13, concluded that pediatric racial minorities are much less likely than whites to get kidney transplants before they need dialysis, regardless of their socioeconomic status. Rachel Patzer, PhD (Emory Transplant Center, Emory Department of Epidemiology), was the study PI, and her co-investigators were Sandra Amaral, MD (Children's Hospital of Philadelphia), Nancy G. Kutner, PhD (Emory Department of Rehabilitation Medicine), and William M. McClellan, MD (Emory Division of Nephrology).

Because the demand for suitable organs for transplant outweighs the supply, most patients with kidney failure must start on dialysis while waiting for a transplant. Dr. Patzer and her colleagues investigated how race and poverty impact access to kidney transplantation before dialysis ― called preemptive transplantation ― among children with kidney failure.

"Among pediatric kidney disease patients in the United States, white patients have a significantly higher rate of getting a kidney transplant without ever starting dialysis compared to blacks and Hispanics," says Dr. Patzer. "The reasons for this racial disparity are not entirely clear, but could be due to lower access to health care among minority patients.”

By analyzing data from the United States Renal Data System from 2000 to 2008, the researchers found that the average annual rate of preemptive transplantation was higher among whites than Hispanics and African Americans. Racial differences were also evident in the type of preemptive transplants children received, where more white patients had living donors (78.8%) vs. Hispanics (57.3%) and African Americans (48.8%). Hispanics had a 50% and African Americans a 56% lower rate of preemptive transplants than whites. Socioeconomic status, as measured by health insurance and neighborhood poverty, did not entirely explain this observed racial disparity.

The same team presented a second, similar study at the conference. Led by Dr. Amaral, "Mortality and Race in Pediatric End-Stage Renal Disease: Who Is Dying before Transplant?" analyzed racial differences in deaths among children with kidney failure. The researchers examined all kidney failure patients under 21 years of age who went on dialysis between January 2000 and September 2008 and did not receive a transplant during the study, which ended in September 2009. The study found that among children with kidney failure waiting for a transplant, African Americans with no health insurance were more likely to die than whites, while Hispanics were less likely to die than other racial groups regardless of insurance status. "More studies are needed to understand why these differences occur," said Dr. Amaral.