title: Dialysis and transplantation among Aboriginal children with kidney failure.
abstract: BACKGROUND
  Relatively little is known about the management and outcomes of Aboriginal children with renal failure in Canada. We evaluated differences in dialysis modality, time spent on dialysis, rates of kidney transplantation, and patient and allograft survival between Aboriginal children and non-Aboriginal children.
  
  
  METHODS
  For this population-based cohort study, we used data from a national pediatric end-stage renal disease database. Patients less than 18 years old who started renal replacement treatment (dialysis or kidney transplantation) in nine Canadian provinces (Quebec data were not available) and all three territories between 1992 and 2007 were followed until death, loss to follow-up or end of the study period. We compared initial modality of dialysis and time to first kidney transplant between Aboriginal children, white children and children of other ethnicity. We examined the association between ethnicity and likelihood of kidney transplantation using adjusted Cox proportional hazard models for Aboriginal and white children (data for the children of other ethnicity did not meet the assumptions of proportional hazards).
  
  
  RESULTS
  Among 843 pediatric patients included in the study, 104 (12.3%) were Aboriginal, 521 (61.8%) were white, and 218 (25.9%) were from other ethnic minorities. Hemodialysis was the initial modality of dialysis for 48.0% of the Aboriginal patients, 42.7% of the white patients and 62.6% of those of other ethnicity (p < 0.001). The time from start of dialysis to first kidney transplant was longer among the Aboriginal children (median 1.75 years, interquartile range 0.69-2.81) than among the children in the other two groups (p < 0.001). After adjustment for confounders, Aboriginal children were less likely than white children to receive a transplant from a living donor (hazard ratio [HR] 0.36, 95% confidence interval [CI] 0.21-0.61) or a transplant from any donor (HR 0.54, 95% CI 0.40-0.74) during the study period.
  
  
  CONCLUSIONS
  The time from start of dialysis to first kidney transplant was longer among Aboriginal children than among white children. Further evaluation is needed to determine barriers to transplantation among Aboriginal children.
authors: Department of Pediatrics, University of Calgary, Calgary, Alta. s.samuel@albertahealthservices.ca
authors: Susan M
authors: SM
authors: Samuel
authors: Bethany J
authors: BJ
authors: Foster
authors: Marcello A
authors: MA
authors: Tonelli
authors: Alberto
authors: A
authors: Nettel-Aguirre
authors: Andrea
authors: A
authors: Soo
authors: R Todd
authors: RT
authors: Alexander
authors: Lynden
authors: L
authors: Crowshoe
authors: Brenda R
authors: BR
authors: Hemmelgarn
references: CMAJ. 2004 Sep 14;171(6):577-82
references: 15367459
references: BMC Nephrol. 2010 Aug 26;11:21
references: 20796306
references: Nephrology (Carlton). 2007 Jun;12(3):299-304
references: 17498127
references: Health Place. 2009 Mar;15(1):390-3
references: 18456539
references: Clin J Am Soc Nephrol. 2011 Apr;6(4):813-8
references: 21258038
references: Am J Kidney Dis. 2004 Dec;44(6):1083-9
references: 15558530
references: Kidney Int. 2009 Sep;76(6):659-64
references: 19553910
references: Am J Public Health. 1989 Jun;79(6):756-8
references: 2786348
references: Am J Kidney Dis. 2005 Dec;46(6):1117-23
references: 16310578
references: Am J Transplant. 2006 Aug;6(8):1875-81
references: 16771809
references: Ethn Health. 2003 May;8(2):111-9
references: 14671765
references: Kidney Int. 2006 Sep;70(5):826-8
references: 16929330
references: Kidney Int. 2006 Sep;70(5):924-30
references: 16788690
references: Nephrology (Carlton). 2003 Feb;8(1):42-8
references: 15012749
references: Pediatr Transplant. 2009 Nov;13(7):856-60
references: 19067910