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. INTERPRETATION: 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.
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. INTERPRETATION: 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: M Tonelli; B Hemmelgarn; A K J Kim; S Bertazzon; S Klarenbach; B Manns; N Wiebe; B Culleton; J S Gill Journal: Kidney Int Date: 2006-06-21 Impact factor: 10.612
Authors: Louise M Moist; Heather A Richards; Dana Miskulin; Charmaine E Lok; Karen Yeates; Amit X Garg; Lilyanna Trpeski; Ann Chapman; Joseph Amuah; Brenda R Hemmelgarn Journal: Clin J Am Soc Nephrol Date: 2011-01-21 Impact factor: 8.237
Authors: Marcello Tonelli; Sophia Chou; Sita Gourishankar; Gian S Jhangri; John Bradley; Brenda Hemmelgarn Journal: Am J Kidney Dis Date: 2005-12 Impact factor: 8.860
Authors: Alan Cass; Joan Cunningham; Kate Anderson; Paul Snelling; Sam Colman; Jeannie Devitt; Cilla Preece; Josette Eris Journal: Nephrology (Carlton) Date: 2007-06 Impact factor: 2.506
Authors: Marcello Tonelli; Brenda Hemmelgarn; Braden Manns; George Pylypchuk; Clara Bohm; Karen Yeates; Sita Gourishankar; John S Gill Journal: CMAJ Date: 2004-09-14 Impact factor: 8.262
Authors: Susan M Samuel; Bethany J Foster; Brenda R Hemmelgarn; Alberto Nettel-Aguirre; Lynden Crowshoe; R Todd Alexander; Andrea Soo; Marcello A Tonelli Journal: CMAJ Date: 2012-08-27 Impact factor: 8.262
Authors: Sang Joseph Kim; Stanley Sa Fenton; Joanne Kappel; Louise M Moist; Scott W Klarenbach; Susan M Samuel; Lianne G Singer; Daniel H Kim; Kimberly Young; Greg Webster; Juliana Wu; Frank Ivis; Eric de Sa; John S Gill Journal: Can J Kidney Health Dis Date: 2014-12-09