Disparities in Postnatal Treatment of Congenital Renal Anomalies [31L

Abstract

INTRODUCTION: Congenital renal anomalies (CRAs), including dysplastic kidneys, lower urinary tract obstruction, and infantile recessive polycystic kidney disease, are often identifiable on antenatal ultrasound and generally confer a poor prognosis for the affected fetus. We sought to evaluate social determinants influencing the postnatal course of infants with CRAs. METHODS: 900 infants with CRAs who developed end-stage renal disease (ESRD) in the first 6 months of life between 1995-2012 were identified in the United States Renal Data System. This information was then linked to the Social Security Master Death File and the United Network for Organ Sharing. Cox proportional hazards models were used to examine associations between race, insurance, and 1) survival and 2) receipt of a kidney transplant. RESULTS: Survival: Black infants with CRAs who developed ESRD in the first 6 months of life had a 1.34-fold higher hazard of death compared to white infants, even after adjusting for insurance type (p=0.02). Private insurance was associated with a non-significant 0.84-fold lower hazard of death. Receipt of a Kidney Transplant: Black and Hispanic infants had 0.59 and 0.79-fold lower rate of transplant compared to white infants, respectively (p < 0.02), even after adjusting for insurance type. Patients with private insurance had a 1.3-fold higher rate of transplant compared to those with public or no insurance (p < 0.001). CONCLUSION: Significant racial disparities exist in the outcomes of CRAs. More research is warranted to discern what patient-level factors are contributory. Outcomes of CRAs by insurance status also suggest a role of system-based factors in postnatal mortality.