Overview of dialysis in indigenous compared to nonindigenous Australians

Introduction: Indigenous Australians (Aboriginal and Torres Strait Islanders, ATSI) make up 3% of the total Australian population [1] and comprised similar to 10% of new patients beginning renal replacement for end-stage kidney disease (ESKD) in Australia during 2013 [2]. In this study, we examined the differences in characteristics, incidence, and prevalence of different modalities of dialysis and survival between indigenous and nonindigenous Australians. Methods: We examined outcomes of all adults (aged >= 18 years at the start of renal replacement therapy (RRT)) in the ANZDATA registry who started RRT from 1st Jan 2003 to 31st Dec 2013 in Australia. Adjusted patient survival on dialysis was calculated using standard techniques. Results: A total of 25,528 participants were included, of whom 2,447 (9.5%) were indigenous Australians. Use of facility hemodialysis was more common among indigenous people, odds ratio (OR) 1.79 (95% confidence interval (CI), 1.37, 2.35). Of several interactions between indigenous status and other comorbidities, the most clinically significant was one with diabetes. In fully adjusted models, compared to nonindigenous with diabetes; death risk was higher for indigenous people with diabetes, HR 1.15 (95% CI, 1.06, 1.25). There was no difference between the two groups without diabetes, HR 0.86 (95% CI, 0.73, 1.05). There was no variation in the risks associated with ethnicity over year of dialysis start. Conclusion: There are differences in adjusted outcomes of indigenous Australians compared to nonindigenous with ESKD. Interactions suggest that the influence of reported comorbidities may differ in this group. Further investigations will be valuable in closing the gap and improving health outcome of indigenous Australians on RRT.