Renal replacement therapy in rural and urban Australia

Background. Australians living in rural regions have poorer health outcomes than city residents. This study compares rural and city patient access to and outcomes of renal replacement therapy (RRT) in Australia. Methods. Non-indigenous Australians aged >= 16 years who commenced dialysis or underwent renal transplantation between 1996 and 2009 and were registered with the Australia and New Zealand Dialysis and Transplant Registry were included. Each patient's location was classified according to a remote area index as major city (MC), inner regional (IR), outer regional (OR) or remote/very remote (REM). Results. A total of 24 068 commenced dialysis and 5399 received a renal transplant during the study period. Patient distribution by remote area index was 71.3 and 70.8% MC, 19.1 and 18.6% IR, 8.4 and 9.1% OR and 1.1 and 1.5% REM for dialysis and transplant patients, respectively. RRT incidence per million population after adjusting for age and gender was 124 [95% confidence interval (CI): 122-126] MC, 106 (95% CI: 103-110) IR, 100 (95% CI: 96-105) OR and 96 (95% CI: 84-109) REM. After controlling for demographic variables, comorbidities and other covariates, hazard ratios for dialysis survival compared to MC were 1.08 (95% CI: 1.03-1.14) IR, 1.19 (95% CI: 1.11-1.28) OR and 1.03 (95% CI: 0.84-1.25) REM. Transplant patient survival was not statistically different by remoteness. Conclusions. Rural Australians have lower incidence of RRT. Whether the causes of the lower RRT reflect lower disease rates or differential treatment access is not known. Differences in outcomes were seen for dialysis but not transplantation.