Background: Black, Hispanic, and American Indian/Alaskan Native (AI/AN) kidney cancer patients have poorer outcomes than White patients. While there is ample literature examining the influence of race and ethnicity on survival, little is known about the association between race and ethnicity and receipt of treatment for kidney cancer. The aim of this study was to explore differences in receipt of treatment and patterns of refusal of recommended treatment by race and ethnicity. Methods: 96,745 patients ages 45-84 with kidney cancer were identified in the Surveillance, Epidemiology, and End Results (SEER) program between 2007 and 2014. Mixed-effects logistic regression models were used to examine the association of race and ethnicity with (1) receipt of surgical treatment, and (2) patient refusal of recommended treatment, with county of residence included as a random effect to account for potential correlation among patients within the same county. Both univariable and multivariable analyses were conducted. Multivariable models were adjusted for gender, age, insurance status, stage at diagnosis, and standardized versions of unemployment status, high school education, and median household income as fixed effects. Results: Black and AI/AN patients had lower odds of undergoing any surgical procedure than White patients (OR=0.76; 95% CI: 0.72-0.80; p<0.001, and OR=0.90; 95% CI: 0.73-1.10; p=0.3, respectively) after adjustment for gender, age, insurance status, stage at diagnosis, unemployment status, education status, and income. Black and AI/AN patients had higher odds of refusing recommended surgery (OR=1.95; 95% CI: 1.57-2.42; p<0.001, and OR=2.13; 95% CI: 1.11-4.10; p=0.024, respectively). Hispanic patients had slightly higher odds of undergoing any surgical procedure (OR=1.09; 95% CI: 1.03-1.16; p=0.003) and lower odds of refusal (OR=0.72; 95% CI: 0.54-0.96; p=0.025, respectively). Conclusions: Compared with White patients, Black patients were less likely to receive potentially life-saving surgery, and both Black and AI/AN patients were more likely to refuse recommended surgery. Further research is necessary to understand underlying causes of these phenomena, which could serve to inform interventions to improve treatment delivery for Black and AI/AN kidney cancer patients.