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Updated: Mar 12, 2026
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Racial-ethnic disparities in mortality and kidney transplant outcomes among pediatric dialysis patients
Marciana Laster1, Melissa Soohoo2, Clinton Hall3
1David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Insights
African-American children on dialysis face higher mortality and lower transplant rates compared to non-Hispanic whites. Hispanic children have similar or lower mortality but also reduced transplant likelihood, differing from adult trends.
Area of Science:
- Pediatric Nephrology
- Health Disparities
- Renal Replacement Therapy
Background:
- Existing research on race and outcomes in pediatric dialysis is limited, particularly regarding Hispanic children.
- Adult hemodialysis studies indicate lower mortality and transplant rates for African-American and Hispanic patients.
- This study addresses the gap in understanding racial-ethnic disparities in pediatric dialysis outcomes.
Purpose of the Study:
- To investigate racial-ethnic disparities in mortality and kidney transplantation among pediatric dialysis patients.
- To compare outcomes across non-Hispanic white, African-American, and Hispanic pediatric dialysis populations.
- To determine if race-ethnicity influences survival and transplant rates in children undergoing dialysis.
Main Methods:
- Retrospective cohort analysis of 2,697 pediatric dialysis patients (ages 0-20).
- Inclusion of non-Hispanic white, African-American, and Hispanic race-ethnic groups.
- Utilized competing risks methods for survival analysis and logistic regression for 1-year outcomes.
Main Results:
- African-Americans exhibited a 64% higher mortality risk compared to non-Hispanic whites (HR=1.64).
- Hispanic patients showed a non-significant 31% lower mortality risk (HR=0.69).
- Both African-American and Hispanic children had significantly lower odds of receiving a kidney transplant within one year (ORs 0.28 and 0.43, respectively).
Conclusions:
- Unlike adults, African-American pediatric dialysis patients experience worse survival than non-Hispanic whites.
- Hispanic pediatric dialysis patients face similar to lower mortality risks but reduced transplant likelihood.
- Racial-ethnic disparities in kidney transplantation access persist in pediatric dialysis patients, mirroring adult trends.
Background:
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.
Methods:
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.
Results:
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).
Conclusion:
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.
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