Treatment Of Kidney Disease In Children Varies By Race

April 01, 1997

Researchers at the Johns Hopkins Children's Center have discovered racial differences in the choice of dialysis method for children with end stage renal disease (ESRD).

Susan L. Furth, M.D., an instructor in the Division of Pediatric Nephrology, and colleagues at Hopkins analyzed data on 1,404 children from the 1990 national Medicare ESRD registry. They found that black children were nearly 2.5 times more likely than whites to receive hemodialysis versus peritoneal dialysis.

Researchers controlled for age, gender, cause and duration of ESRD, income, education, and treatment facility characteristics. The abstract appears in the April issue of Pediatrics; the full study is available on Pediatrics electronic pages (

"Black-white disparities in the use of specific medical and surgical services have been reported in adult populations," says Furth, "but such variations are not well documented in children."

After breaking the statistics into age groups, Furth and colleagues found that black children younger than nine were more than two times more likely than white children to be on hemodialysis rather than peritoneal dialysis. Black children between ages nine and 14 were more than four times more likely to be on hemodialysis. In the 14-to-19-year age group, blacks were 50 percent more likely to be on hemodialysis than peritoneal dialysis.

Says Furth, "We need to understand why such a wide disparity in treatment occurs. Possible explanations include cultural differences in attitudes toward or preference for one treatment, or racial differences in access to care."

Though kidney transplantation is the preferred treatment for children with chronic renal failure, many children need dialysis while awaiting transplants, and some are not transplant candidates.

Hemodialysis uses a dialyzer (filter) connected to a machine to clean the blood. During treatment, blood travels through tubes into the dialyzer, where wastes and extra fluids are removed. Then the newly cleaned blood flows through another set of tubes and back into the body. Most patients on hemodialysis must visit the hospital several times each week, for hours at a stretch. Home hemodialysis requires training and space for the equipment.

Peritoneal dialysis uses the lining of the abdomen to filter blood. A cleansing solution, called dialysate, is introduced into the abdomen via a catheter. Fluid, wastes, and chemicals pass from tiny blood vessels in the peritoneal membrane into the dialysate. After several hours, the dialysate is drained from the abdomen and replaced with new solution.

Peritoneal dialysis can be done in the home and requires no equipment and minimal supervision. According to Furth, it is widely regarded as, though not proven to be, the optimal form of renal replacement therapy. Peritoneal dialysis has been associated with better growth and improved metabolic control, as well as opportunities for improved school attendance, better psychosocial coping skills, and less depression.

"Determining the precise cause of this substantial difference in treatment choice by race clearly will require further studies to address these issues. This research lays the groundwork to further examine the factors responsible for the different treatment choices made in the care of children with chronic disease," says Furth.

Approximately 1,000 children are diagnosed with ESRD each year. At any given time, 4,000 children in the United States are affected. Annual costs of the disease in this country topped $11 billion in 1994.

Furth's colleagues in the study include Neil R. Powe, M.D., Wenke Hwang, M.S., Alicia Neu, M.D., and Barbara Fivush, M.D.

The Johns Hopkins Children's Center is the children's hospital of The Johns Hopkins Medical Institutions. Maryland's most comprehensive acute-care hospital for children, the center, with its 177-bed hospital and more than 40 divisions and services, treats some 8,000 inpatients annually, with more than 90,000 outpatient visits.


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