Black Kids Receive Inferior Medical Treatment for Kidney Disease

Although black-white disparities in the use of specific medical and surgical services have been reported in adult populations, such variations are not well documented in children.

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

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.

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.

"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.