title: Use and outcomes of peritoneal dialysis among Aboriginal people in Canada.
abstract: There has been a dramatic increase in the incidence of ESRD among Aboriginal people in North America. Although peritoneal dialysis (PD) seems to be the dialysis modality of choice for this often rural-dwelling population, few data exist to confirm this. This study was conducted to evaluate rates of PD use, technique failure, and mortality among incident Aboriginal dialysis patients. Adults of white or Aboriginal race who initiated dialysis in three Canadian provinces between January 1, 1990, and December 31, 2000, were included and followed until December 31, 2001. Logistic regression and Cox proportional hazards models were used to examine adjusted associations between Aboriginal race and PD use, technique failure, and mortality. Among the 3823 patients of white (n = 3138; 82.1%) or Aboriginal (n = 685; 17.9%) race, 835 (21.8%) initiated dialysis on PD. After adjustment for age and comorbidity and comparison with white patients, Aboriginal patients were significantly less likely to initiate therapy on PD compared with white patients (odds ratio, 0.51; 95% confidence interval, 0.40 to 0.65), with a nonsignificant trend toward a higher risk for technique failure (hazards ratio, 1.46; 95% confidence interval, 0.95 to 2.23). Adjusted survival among Aboriginal PD patients seemed similar to both white PD patients and Aboriginal patients who were treated with hemodialysis. In summary, among people who were treated with dialysis in Canada, PD was used less frequently in Aboriginal patients than in those of white race. Although Aboriginal patients who initiate dialysis on PD seemed more likely to experience technique failure, their adjusted risk for death was similar to that of white patients. Future studies should address barriers to the initiation and maintenance of PD in the Aboriginal population, especially those who reside in rural locations.
authors.affiliation: Division of Nephrology, University of Alberta, 7-129 Clinical Science Building 8440, 112 Street, Edmonton, Alberta T6G 2G3 Canada. mtonelli@ualberta.ca
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.forename: Brenda
authors.initials: B
authors.lastname: Hemmelgarn
authors.forename: Braden
authors.initials: B
authors.lastname: Manns
authors.forename: Sara
authors.initials: S
authors.lastname: Davison
authors.forename: Clara
authors.initials: C
authors.lastname: Bohm
authors.forename: Sita
authors.initials: S
authors.lastname: Gourishankar
authors.forename: George
authors.initials: G
authors.lastname: Pylypchuk
authors.forename: Karen
authors.initials: K
authors.lastname: Yeates
authors.forename: John S
authors.initials: JS
authors.lastname: Gill
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000416:Alberta / Q000453:epidemiology; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D015994:Incidence; D007198:Indians, North American / Q000706:statistics & numerical data*; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010530:Peritoneal Dialysis / Q000379:methods / Q000706:statistics & numerical data*; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate; D016896:Treatment Outcome