TY - JOUR
T1 - Racial differences in renal replacement therapy initiation among children with a nonglomerular cause of chronic kidney disease
AU - Ng, Derek K.
AU - Moxey-Mims, Marva
AU - Warady, Bradley A.
AU - Furth, Susan L.
AU - Muñoz, Alvaro
N1 - Funding Information:
Data in this article were collected by the Chronic Kidney Disease in children prospective cohort study (CKiD) with clinical coordinating centers (principal investigators) at Children's Mercy Hospital and the University of Missouri, Kansas City (Bradley Warady, MD) and Children's Hospital of Philadelphia (Susan Furth, MD, PhD), Central Biochemistry Laboratory (George Schwartz, MD) at the University of Rochester Medical Center, and data coordinating center (Alvaro Muñoz, PhD) at the Johns Hopkins Bloomberg School of Public Health. The CKiD Study is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases , with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development , and the National Heart, Lung, and Blood Institute ( U01-DK-66143 , U01-DK-66174 , U01-DK-082194 , U01-DK-66116 ). The CKiD web site is located at http://www.statepi.jhsph.edu/ckid . The authors acknowledge Deidra Crews for critical input in the preparation of this article.
Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Purpose 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). Methods 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. Results 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. Conclusions 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.
AB - Purpose 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). Methods 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. Results 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. Conclusions 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.
KW - Chronic kidney disease
KW - Health disparities
KW - Inverse probability weights
KW - Pediatric nephrology
KW - Renal replacement therapy
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U2 - 10.1016/j.annepidem.2016.09.011
DO - 10.1016/j.annepidem.2016.09.011
M3 - Article
C2 - 27789133
AN - SCOPUS:84994893477
SN - 1047-2797
VL - 26
SP - 780-787.e1
JO - Annals of epidemiology
JF - Annals of epidemiology
IS - 11
ER -