Children’s Access to Kidney Transplantation Affected by Racial Disparities

Highlights

• Children suffering from kidney failure need access to healthy kidneys from living or deceased donors to improve their quality of life.
• Reduced access to kidney transplantation contributes to an increased risk of death in black children with kidney failure.
Racial differences exist among children in their access to kidney transplantation.
Researchers show that there is a higher risk of death in black compared to white children with kidney failure over the last two decades this may be due to the racial differences in access to kidney transplantation.


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‘Understanding the differences in transplantation and death rates by race will help in implementing strategies to ensure equal access to transplantation for children.’

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Kidney disease in children interferes with normal growth and functioning. As a result, children with kidney failure are given high priority in the allocation of deceased donor kidneys. But the existence of racial disparities in kidney allocation is not clear.

Chronic kidney disease (CKD) leads to irreversible kidney damage that can further progress to end-stage renal disease (ESRD). Most children with ESRD start on dialysis and then receive a transplant.

During the past 30 years, the numbers of children and adolescents with end-stage renal disease has grown dramatically, according to the U.S. Centers for Disease Control and Prevention (CDC).


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Roughly one in 65,000 children develop end-stage renal disease each year, and kidney transplant is the primary method for treating the condition in the pediatric population. The average age of transplant recipients at the time of transplant was 10.9 years.

Congenital disorders, including congenital anomalies of the kidney and urinary tract and hereditary nephropathies, are responsible for about two thirds of all cases of CKD in developed countries.


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While the survival rate of children with ERSD has improved, it remains about 30 times lower than that of healthy peers.

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To investigate whether there are racial disparities in the survival of children with kidney failure, Elaine Ku, MD (University of California San Francisco) and her colleagues analyzed information on 12,123 children belonging to non-Hispanic black, Hispanic, and non-Hispanic white ethnicity.

These children had started renal replacement therapy either in the form of dialysis or transplantation, between 1995 and 2011 and they were followed up through 2012.

During a median follow-up of 7.1 years, researchers found that-

• 1600 children had died
• Black children had a 36% higher risk of death than white children, which was mostly attributed to differences in access to transplantation
• Hispanic children had lower risk of death than non-Hispanic white children even though they had lower access to transplantation
There was no longer an appreciable difference in the survival in black and white children, when accounted for black children's reduced access to transplantation.

"We believe it is critically important to understand differences in transplantation and death by race so that changes can be made to either the allocation of donated organs or current practices in the treatment of kidney disease in children to eliminate the differences that we observed," said Dr. Ku.

The findings,appear in the Journal of the American Society of Nephrology, (JASN), highlight the need to develop strategies that will ensure equal access to transplantation for children.

Reference


1. Epidemiology of chronic kidney disease in children - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3264851/)
2. Blood condition is highly predictive of graft failure in pediatric kidney transplant - (https://www.ucdmc.ucdavis.edu/publish/news/newsroom/6791)
3. Elaine Ku et al. Racial and Ethnic Disparities in Survival of Children with ESRD. Journal of American Society of Nephrology; (2016) doi: 10.1681/ASN.2016060706


Source-Medindia