End-stage kidney disease (ESKD) and earlier stages of chronic kidney disease (CKD) represent one of the most dramatic examples of racial/ethnic disparities in health in our nation. African Americans are three times more likely to require renal replacement therapy then their non-Hispanic White counterparts. This article describes CKD-related disparities linked to a variety of clinical, socio-economic, and cultural factors, as well as to select social determinants of health that are defined by social positioning and often by race within the United States. Our advancing understanding of these issues has led to improvements in patient outcomes and is narrowing the gap in disparities across most aspects of CKD and CKD risk factors. There are also extensive data indicating similar improvements in quality measures for patients on dialysis. This article also reviews the state of CKD in African Americans from a population perspective and provides recommendations for the way forward.

Importance Previous studies in adult hemodialysis patients have shown that African-American and Hispanic patients have lower mortality risk as well as 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. Objective To determine if racial-ethnic disparities in mortality and kidney transplantation outcomes exist in pediatric dialysis patients. Design, setting, and participants Retrospective cohort analysis of 2,697 pediatric dialysis patients (ages 0–20 years) from a large national dialysis organization (entry period 2001–2011) Exposures Race-ethnicity (non-Hispanic white, African-American, Hispanic) Main Outcomes and Measures Associations of 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 one 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 to non-Hispanic whites, African-Americans had a 64% higher mortality risk (HR = 1.64; 95% CI, 1.24, 2.17) while 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 a higher odds of one-year mortality after starting dialysis (OR=2.08; 95% CI, 0.95, 4.58), while both African-Americans and Hispanics had a lower odds of receiving a transplant within one year of starting dialysis (OR=0.28; 95% CI, 0.19, 0.41 and OR=0.43; 95% CI, 0.31, 0.59, respectively). Conclusions and Relevance In contrast to adults, African-American pediatric dialysis patients have worse survival compared to their non-Hispanic white counterparts, while Hispanics have similar to lower mortality risk. Both African-American and Hispanic pediatric dialysis patients had lower likelihood of kidney transplantation compared to non-Hispanic whites, similar to observations in the adult dialysis population.

One of the ultimate goals of successful solid organ transplantation in pediatric recipients is attaining an optimal final adult height. This manuscript will discuss growth following transplantation in pediatric recipients of kidney, liver, heart, lung or small bowel transplants. Remarkably similar factors impact growth in all of these recipients. Age is a primary factor, with younger recipients exhibiting the greatest immediate catch-up growth. Graft function is a significant contributing factor, with a reduced glomerular filtration rate correlating with poor growth in kidney recipients and the need for re-transplantation with impaired growth in liver recipients. The known adverse impact of steroids on growth has led to modification of the steroid dose and even steroid withdrawal and avoidance. In kidney and liver recipients, this strategy has been associated with the development of acute rejection. In infant heart transplantation, avoiding maintenance corticosteroid immunosuppression is associated with normal growth velocity in the majority of patients. With marked improvements in patient and graft survival rates in pediatric organ recipients, quality of life issues, such as normal adult height, should now receive paramount attention. In general, normal growth following solid organ transplantation should be an achievable goal that results in normal adult height.