Racial and Center Differences in Hemodialysis Adequacy in Children Treated at Pediatric Centers

Abstract

Abstract. This study assessed hemodialysis adequacy in pediatric centers. Monthly adequacy data were requested in NAPRTCS enrollees on hemodialysis for at least 6 mo. Data forms were returned for 147 children from 32 centers. Data are presented for the 138 children (57% boys, 45% black) that were dialyzed 3 times/wk, representing 2282 patientmonths of follow-up. Pre-and postdialysis BUN levels were reported in all children. Kt/V values were reported in 76 children; however, sufficient data were obtained to calculate Kt/V in 129 children. On average, 14.9 Kt/V and 15.2 urea reduction ratio (URR) values were calculated per child. Aggregate dialysis dose was defined as adequate if Kt/V was Ͼ1.2 in at least 75% of calculated Kt/V measures within a subject. Mean Ϯ SD age was 11.3 Ϯ 3.7 yr (median, 12.0 yr). Hemodialysis dose was variable within subjects (median CV%: URR 8.2, Kt/V 16.9). Aggregate dialysis dose was adequate in 70% of subjects. Multivariate logistic regression showed male gender (OR, 0.41; 95% CI, 0.16 to 0.98), black race (OR, 0.28; 95% CI, 0.11 to 0.67), larger body surface area (fourth versus first quartile: OR, 0.22; 95% CI, 0.05 to 0.80), and absence of reported Kt/V at the treating center (OR, 0.26; 95% CI, 0.10 to 0.62) were significant predictors of inadequate dialysis dose. Age, renal diagnosis, and center size were not associated with adequacy. Racial and gender disparities in hemodialysis dose existed among children at specialized academic pediatric centers and a substantial proportion received inadequate hemodialysis.

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

“…Similar to findings by Leonard et al, African American children were found to have less adequate dialysis than white children (23). Despite the presence of these differences, stratification demonstrates that disparities in survival persist in African American patients with appropriate spKt/V values.…”

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

“…No difference was observed, despite the White patients in this cohort being smaller (as indicated by height and weight SDS) than the Black patients, which might be expected to result in higher estimations of clearance among White peritoneal dialysis patients. This finding is in contrast to that in studies of pediatric hemodialysis patients, where Black patients have been shown to be more likely to receive a dialysis dose below the recommended KDOQI minimum than Whites [16].…”

Intermediate-term patency of upper arm arteriovenous fistulae for hemodialysis access in children

“…In this pediatric population, adequate access creation is difficult and is complicated by the additional responsibility to preserve future access sites in children who may require chronic hemodialysis [2]. The types of access used in children, in decreasing order of popularity, include catheters, arteriovenous fistulae, and arteriovenous grafts [1]. The Vascular Access group publishes clinical practice guidelines and recommendations on hemodialysis access placement.…”

“…Pediatric patients requiring hemodialysis comprise less than 1% of the total population on hemodialysis in the United States [1]. In this pediatric population, adequate access creation is difficult and is complicated by the additional responsibility to preserve future access sites in children who may require chronic hemodialysis [2].…”