Patient and allograft survival of Indo Asian and East Asian dialysis patients treated in Canada.
Kidney failure is relatively common among Canadians of Asian origin. However, little is known about the health outcomes after initiation of renal replacement therapy in this population. Our study evaluates differences in the likelihood of renal transplantation and graft loss among Asian and white patients. We studied 21 523 adults of East Asian, Indo Asian or white ethnicity who had initiated dialysis in Canada from 1990-2000. Subjects were followed until death, loss to follow-up or end of study (2004). The proportion of the eligible subjects who were East Asian, Indo Asian, or white was 6, 3, and 91%, respectively. Compared to white patients, East Asian and Indo Asian patients were significantly less likely to receive a renal transplant after adjusting for potential confounding factors. This disparity is greater for transplants from living donors as compared to those from deceased donors. The adjusted death censored graft loss in transplant recipients was not significantly different between ethnic groups. The adjusted risk of death following transplantation, however, was significantly lower in Indo Asian than in white patients. Our findings show that in a Canadian population, patients of East Asian or Indo Asian origin had lower rates of renal transplantation than white patients, especially for living donor transplantation. These findings warrant further study, especially given the good graft outcomes in these individuals.
Tonelli
M
M
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. mtonelli@ualberta.ca
Hemmelgarn
B
B
Gill
J S
JS
Chou
S
S
Culleton
B
B
Klarenbach
S
S
Manns
B
B
Wiebe
N
N
Gourishankar
S
S
D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data*; D002170:Canada / Q000453:epidemiology; D005202:Asia, Eastern / Q000208:ethnology; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007194:India / Q000208:ethnology; D007676:Kidney Failure, Chronic / Q000208:ethnology* / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016030:Kidney Transplantation / Q000401:mortality*; D019520:Living Donors / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000401:mortality*; D018570:Risk Assessment; D013997:Time Factors; D014184:Transplantation, Homologous / Q000706:statistics & numerical data; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data*