title: Peritoneal dialysis outcomes of Indigenous Australian patients of remote Kimberley origin.
abstract: OBJECTIVE
  To compare clinical outcomes and mortality rates between Kimberley Indigenous, other Indigenous and non-Indigenous Australian patients on peritoneal dialysis (PD).
  
  
  METHODS
  Patients commencing renal replacement therapy (RRT) with PD for the first time from 1 January 2003 to 31 December 2009 were retrospectively identified. Secondary data from medical records and the Australian and New Zealand Dialysis and Transplant Registry from 1 January 2003 to 31 December 2010 were used to compare outcomes between patients.
  
  
  METHODS
  Time to first peritonitis; failure and death rates per 100 patient-years, hazard ratios, unadjusted and adjusted (for age, sex, comorbid conditions, PD not the first RRT modality used). Comparison of the two PD systems used in the Kimberley.
  
  
  RESULTS
  Kimberley patients had significantly shorter median time to first peritonitis (11.2 versus 21.5 months), higher technique failure (46.0 versus 25.2 per 100 patient-years) and shorter median survival on PD (17.5 versus 22.4 months) but similar adjusted mortality (hazard ratio 1.32; 95% CI, 0.76-2.29) as non-Indigenous patients. They also had a significantly higher technique failure rate than other Indigenous patients (46.0 versus 31.4 per 100 patient-years) and nearly double the average peritonitis episodes previously reported for Indigenous Australians (2.0 versus 1.15 per patient-year).
  
  
  CONCLUSIONS
  PD can bring patients closer to home; however, it is relatively short term and potentially hazardous. PD remains an important therapy for suitable remote patients to get closer to home, providing they are fully informed of the options. The current expansion of safer Kimberley haemodialysis options needs to continue.
authors.affiliation: The Rural Clinical School of Western Australia, The University of Western Australia, Broome, Western Australia, Australia; Kimberley Aboriginal Medical Services Council, Broome, Western Australia, Australia.
authors.forename: Julia V
authors.initials: JV
authors.lastname: Marley
authors.forename: Sarah
authors.initials: S
authors.lastname: Moore
authors.forename: Cherelle
authors.initials: C
authors.lastname: Fitzclarence
authors.forename: Kevin
authors.initials: K
authors.lastname: Warr
authors.forename: David
authors.initials: D
authors.lastname: Atkinson
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D010530:Peritoneal Dialysis / Q000401:mortality; D010538:Peritonitis / Q000401:mortality; D012189:Retrospective Studies; D012424:Rural Population; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Aboriginal; Indigenous; Torres Strait Islander; mortality rate; peritoneal dialysis; peritonitis