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Use and Outcomes of Peritoneal Dialysis among Aboriginal People in Canada

Marcello Tonelli^*,,, Brenda Hemmelgarn^,||, Braden Manns^,,||, Sara Davison^*, Clara Bohm^¶, Sita Gourishankar^*, George Pylypchuk^#, Karen Yeates^** and John S. Gill^,

^* Department of Medicine, Division of Nephrology, and Division of Critical Care Medicine, University of Alberta, and Institute of Health Economics, Edmonton, Alberta, Canada; Department of Medicine, Division of Nephrology and ^|| Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; ^¶ Department of Medicine, Section of Nephrology, Winnipeg Health Sciences Centre, Winnipeg, Manitoba, Canada; ^# Department of Medicine, Division of Nephrology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; ^** Department of Medicine, Division of Nephrology, Queen’s University, Kingston, Ontario, Canada; Division of Nephrology, St. Paul’s Hospital, Vancouver, British Columbia, Canada; and Division of Nephrology, Tufts-New England Medical Center, Boston, Massachusetts

Address correspondence to: Dr. Marcello Tonelli, Division of Nephrology, University of Alberta, 7-129 Clinical Science Building 8440, 112 Street, Edmonton, Alberta T6G 2G3 Canada. Phone: 780-407-8716; Fax: 780-407-7878; E-mail: mtonelli{at}ualberta.ca

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.

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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673