A recent study compared the start of renal replacement therapy (RRT) in African-American (AA) children with chronic kidney disease (CKD) to non-AA children, and found that African-American kids have earlier RRT, later kidney transplants, and shorter times to dialysis, after accounting for socioeconomic status (SES).
The study, “Racial differences in renal replacement therapy initiation among children with a nonglomerular cause of chronic kidney disease,” was published in Annals of Epidemiology.
In patients with chronic kidney disease, the kidneys do not properly perform their function in removing waste from the blood. In the U.S., the disease affects nearly 20 million people. Patients with African-American backgrounds showed an elevated rate of kidney disease progression and incidence of end-stage renal disease (ESRD) when compared to non-AA counterparts. The socioeconomic status (SES) of the patients may also play a role for both adults and children with CKD.
In this study, the researchers aimed to clarify how African-American children with chronic kidney disease compare with non-AA CKD children in terms of RRT, dialysis, and kidney transplant.
A total of 603 children (493 non-African-American; 110 African-American; median age 10 years) with CKD were included and analyzed. The researchers then examined RRT after the onset of CKD, including first dialysis and kidney transplant.
They found that African-American children have the first RRT on average 3.2 years earlier than non-AA children. This median time was reduced to about 1.6 years when the socioeconomic status (SES) of the patients was taken into consideration.
The reason for this was related to the quick decline in the process of making urine called glomerular filtration rate observed in AA patients. Additional data suggested that African-American children have shorter times to dialysis, a treatment offered as a first therapy for ESRD among African-American children compared to transplants, and longer waiting periods for kidney transplants.
“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,” the study’s authors wrote.
“This suggests that factors outside of physician roles may be more effective to reduce these differences, such as public health interventions to increase donor availability, promote patient and family adherence to therapy, and encourage completion of the transplant evaluation process for activation on the transplant waiting list,” they added.