have similar incidence rates until their early teens, when incidence rates among blacks begin to exceed those among whites. By ages 16 to 18 years, rates among blacks are about twice those among whites.

The increasing incidence in younger age groups combined with improved survival resulted in nearly a twofold increase in prevalence of pediatric patients between 1978 and 1987 (Table 5-1). In 1988, there were 833 new pediatric patients in the Medicare ESRD program, or 2.3 percent of all new patients; prevalence was 4,069, or 2.8 percent of all patients.

Many quality-of-life factors are unique to pediatric patients. These include growth retardation, delayed pubertal development, transfusion-dependent anemia, bone and neurologic abnormalities, as well as psychosocial and educational problems. The burdens common to all ESRD patients are often greater for pediatric patients.

The increased incidence and survival of infants and preschool children with ESRD leads to increased comorbidities and treatment problems in the older pediatric population. Major physical problems, such as bone deformities and inhibited growth, are more severe in infants and young children than in those who acquire ESRD at older ages.

Transplantation is the preferred treatment for almost all children; the needs for physical growth and pubertal development are better met through transplantation than dialysis. Table 5-2 shows the change between 1978 and