Document Type
Article
Publication Date
9-2026
Identifier
DOI: 10.1007/s00467-026-07247-0; PMCID: PMC13178790
Abstract
BACKGROUND: Slower chronic kidney disease (CKD) progression allows more time for transplant preparation. Whether differences in CKD progression by race/ethnicity associate with preemptive or living donor transplantation in youth has not been well studied.
METHODS: We examined the association between time spent with low eGFR (between 10-30 mL/min/1.73 m2) and odds of preemptive or living donor transplantation among youth with CKD. eGFR was estimated using the bedside Schwartz (if < 18 years) and CKD-EPI 2021 equations (if ≥ 18 years) and the CKiD U25 equation in sensitivity analysis. Time spent with low eGFR was compared by race/ethnicity.
RESULTS: Among 333 youth with CKD (median age 11 years [IQR 7,14]), median time spent with low eGFR was 28.8 months. 77% were preemptively waitlisted, and 45% received preemptive transplantation (56% of White and 24% of Black youth). Black (vs. White) youth had shorter time with low eGFR (-6.5 months; 95% CI -11.5, -1.4). Time with low eGFR did not differ across other groups. Findings were similar using the U25 equation. Every additional year spent with low eGFR was associated with higher odds of preemptive (OR 1.45; 95% CI 1.24-1.70) and living donor transplantation (OR 1.42; 95% CI 1.21-1.67), but not preemptive waitlisting (OR 0.96; 95% CI 0.83-1.11) in unadjusted analyses.
CONCLUSIONS: Longer time spent with low eGFR is associated with greater odds of preemptive and living donor transplantation. Earlier transplant referral for all children, especially Black youth, may help improve access to preemptive and living donor transplantation.
Journal Title
Pediatric nephrology (Berlin, Germany)
Volume
41
Issue
9
First Page
2979
Last Page
2988
MeSH Keywords
Adolescent; Child; Female; Humans; Male; Black or African American; Disease Progression; Glomerular Filtration Rate; Health Services Accessibility; Kidney Transplantation; Living Donors; Renal Insufficiency, Chronic; Time Factors; Waiting Lists; White People; Black People; White
PubMed ID
41940939
Keywords
CKD; Pediatrics; Transplant; eGFR
Recommended Citation
Ku E, Copeland T, McCulloch CE, et al. Association between estimated time with low glomerular filtration rate and access to transplant among youth with advanced chronic kidney disease. Pediatr Nephrol. 2026;41(9):2979-2988. doi:10.1007/s00467-026-07247-0
Comments
Grants and funding
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Publisher's Link: https://link.springer.com/article/10.1007/s00467-026-07247-0