title: Adverse outcomes among Aboriginal patients receiving peritoneal dialysis.
abstract: BACKGROUND
  The Aboriginal population in Canada experiences high rates of end-stage renal disease and need for dialytic therapies. Our objective was to examine rates of mortality, technique failure and peritonitis among adult aboriginal patients receiving peritoneal dialysis in the province of Manitoba. We also aimed to explore whether differences in these rates may be accounted for by location of residence (i.e., urban versus rural).
  
  
  METHODS
  We included all adult patients residing in the province of Manitoba who received peritoneal dialysis during the period from 1997-2007 (n = 727). We extracted data from a local administrative database and from the Canadian Organ Replacement Registry and the Peritonitis Organism Exit-sites/Tunnel infections (POET) database. We used Cox and logistic regression models to determine the relationship between outcomes and Aboriginal ethnicity. We performed Kaplan-Meier analyses to examine the relationship between outcomes and urban (i.e., 50 km or less from the primary dialysis centre in Winnipeg) versus rural (i.e., more than 50 km from the centre) residency among patients who were aboriginal.
  
  
  RESULTS
  One hundred sixty-one Aboriginal and 566 non-Aboriginal patients were included in the analyses. Adjusted hazard ratios for mortality (HR 1.476, CI 1.073-2.030) and adjusted time to peritonitis (HR 1.785, CI 1.352-2.357) were significantly higher among Aboriginal patients than among non-Aboriginal patients. We found no significant differences in mortality, technique failure or peritonitis between urban- or rural-residing Aboriginal patients.
  
  
  CONCLUSIONS
  Compared with non-Aboriginal patients receiving peritoneal dialysis, Aboriginal patients receiving peritoneal dialysis had higher mortality and faster time to peritonitis independent of comorbidities and demographic characteristics. This effect was not influenced by place of residence, whether rural or urban.
authors.affiliation: Departments of Medicine, St. Boniface Hospital, Winnipeg, Man. msood@sbgh.mb.ca
authors.forename: Manish M
authors.initials: MM
authors.lastname: Sood
authors.forename: Paul
authors.initials: P
authors.lastname: Komenda
authors.forename: Amy R
authors.initials: AR
authors.lastname: Sood
authors.forename: Martina
authors.initials: M
authors.lastname: Reslerova
authors.forename: Mauro
authors.initials: M
authors.lastname: Verrelli
authors.forename: Chris
authors.initials: C
authors.lastname: Sathianathan
authors.forename: Loretta
authors.initials: L
authors.lastname: Eng
authors.forename: Amanda
authors.initials: A
authors.lastname: Eng
authors.forename: Claudio
authors.initials: C
authors.lastname: Rigatto
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008350:Manitoba; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D016016:Proportional Hazards Models; D044469:Racial Groups; D012424:Rural Population; D016896:Treatment Outcome; D014505:Urban Population