Disparate outcomes in pediatric peritoneal dialysis patients by gender/race in the End-Stage Renal Disease Clinical Performance Measures project

Abstract

Associations between achievement of adult Kidney Disease Outcomes Quality Initiative (KDOQI) targets for hemoglobin, adequacy and albumin, and race and gender were determined for pediatric peritoneal dialysis patients from the End-Stage Renal Disease (ESRD) Clinical Performance Measures (CPM) project for the period October 2004-March 2005. Fifty-six percent (427/761) of patients were male. Sixty-six percent (500/761) of patients were White. There were no differences in achievement of targets for adults by gender, and no differences in adequacy parameters by race. Blacks had lower mean hemoglobin levels than did Whites (11.1 +/- 1.6 g/dl vs 11.8 +/- 1.4 g/dl, P < 0.0001). Blacks were more likely to have mean hemoglobin levels < 10 g/dl (24% vs 11%, P < 0.0001) and less likely to achieve mean hemoglobin > 11 g/dl (56% vs 72%, P < 0.0001). Whites were more likely to achieve mean serum albumin levels > 4.0/3.7 g/dl [bromocresol green/bromocresol purple (BCG/BCP)] than Blacks were (35% vs 26%, P = 0.0376). In multivariate logistic regression models, White race was associated with mean hemoglobin levels > 11 g/dl [adjusted odds ratio (adj OR) 2.7, 95% confidence interval (CI) 1.7, 4.3] and mean serum albumin > 4.0/3.7 g/dl (BCG/BCP) (adj OR 1.9, 95% CI 1.3, 2.9]. Further study is needed of factors associated with anemia on peritoneal dialysis and barriers to its correction.

The Factors Affectıng The Effıcıency Of Contınuous Ambulatory Perıtoneal Dıalysıs In Chıldren

“…Anemia may adversely affect hemodynamics in CRF patients and thus impair dialysis adequacy. 36,37 In our study, no statistically significant relationship was found between hemoglobin levels and dialysis adequacy.…”

“…With peritoneal dialysis, albumin and protein are lost. 36,37 Albumin level is an important parameter showing dialysis adequacy. In our study, no statistically significant relationship was found between albumin levels and parameters of dialysis adequacy.…”

Racial–ethnic disparities in mortality and kidney transplant outcomes among pediatric dialysis patients

“…This relationship is also seen in adult hemodialysis patients (21). Atkinson et al showed that African-American children on peritoneal dialysis were less likely to achieve hemoglobin values of 11 g/dL or greater when compared to white children (22). Given the presence of a greater disparity in mortality in children who do not achieve target hemoglobin values, further work is necessary to address the etiologies in disparate hemoglobin values.…”