Does Race Impact Mortality Rates in Patients with End-stage Renal Disease?

- Sandra Amaral, MD, MHS, Children’s Hospital of Philadelphia

“Among children with end-stage kidney disease, death risk is much lower for those who receive a kidney transplant after their diagnosis than for those who remain on dialysis.”

Philadelphia — During a press conference at Kidney Week 2011, Sandra Amaral, MD, MHS, Children’s Hospital of Philadelphia, stressed how important it is for pediatricians and pediatric nephrologists to promote the process of kidney transplant to happen as soon as possible in children who are diagnosed with ESRD. She explained evidence suggests that through a transplant, it will improve the mortality and morbidity in the children compared to being on dialysis; children on dialysis have a much higher risk of death than those who receive a kidney transplant.

Amaral shared the results of a study in which she and her fellow researchers evaluated mortality rates after new diagnoses of end-stage renal disease (ESRD) to see if they varied by race. A secondary focus of the study was “to examine whether insurance status and/or neighborhood poverty influenced racial differences” (Amaral, PowerPoint). Additionally, Amaral and her colleagues sought to answer two questions:

1. Why don’t patients get transplanted?
2. Who are those patients who are remaining on dialysis and having this higher risk of death?

Using the United States Renal Data System national ESRD database, Amaral et al. identified 8,146 children who met the inclusion criteria and tracked them through September 2009. During that time, 896 (approximately 10%) of the children died before receiving a transplant; and of the 896, 735 (82%) died even before making the waiting list, and 161 (18%) died while on the waiting list.

Upon reviewing the results, Amaral et al. found that the patients who died were most likely to be black children with public insurance and living in poorer neighborhoods than Hispanics and whites. In fact, the Hispanic population had the lowest risk of mortality regardless of insurance status. When comparing the insurance status between blacks and whites, the data showed that uninsured blacks had a 78% higher mortality risk than uninsured whites.

Based on these findings, the Amaral et al. learned the following:

1. Health insurance may impact the mortality rate
2. There was no significant difference by race in the neighborhood
3. Need more studies to confirm their findings

"I think that this study brings to life that there may be issues in patient access to care and so it’s possible that the reason patients aren’t even getting wait-listed after their diagnosis is that they’re too sick,” said Amaral. “Perhaps if they were in the system receiving pediatric sub-specialty care earlier, we could prolong their lifespan and improve their health.”