Atkinson MA, et al. - Using the CKiD cohort, researchers analyzed the pediatric population to characterize the transition to renal replacement therapy (RRT), including the prevalence of dialysis as the first RRT vs preemptive kidney transplant (PKT) and graft survival. Among CKiD enrollees, 258 children have started RRT and 202 had post-RRT start data obtained via phone or in-person follow-up. Dialysis was received by 61% as the first RRT modality and PKT by 39%. Less chance of having a glomerular disease and of being African-American was reported for those with PKT, these individuals had higher household-income. By 4 years, graft failure was detected in only 5% of PKT individuals vs 16% of those initially managed with dialysis; however, attenuation of the influence of dialysis exposure was noted following adjustment. Compared with nationally-reported rates, PKT was more often received by CKiD individuals. The chance of receiving a kidney transplant within 1 year of initiating dialysis was more in these people. Reduced access to PKT was reported in relation to African-American race and lower household-income.