01856nas a2200205   4500000000100000008004100001100001400042700001500056700001500071700001500086700001600101700001400117700001400131245012700145250001500272300001100287490000700298520129900305020004601604       2009                            d1 aCass Alan1 aSequist T.1 aTrpeski L.1 aAyanian J.1 aMcDonald S.1 aYeates K.1 aJardine M00aIndigenous people in Australia, Canada, New Zealand and the United States are less likely to receive renal transplantation  a2009/06/26  a659-640 v763 a<p>
In Australia, Canada, New Zealand, and the United States indigenous people have high rates of chronic kidney disease but poor access to effective therapies. To more fully define these issues, we compared the demographics of renal transplantation of indigenous patients in these 4 countries. Data encompassing 312,507 indigenous and white patients (18-64 years of age) who initiated dialysis within an 11-year period ending in 2005 were obtained from each country's end-stage kidney disease registry. By the study's end, 88,173 patients had received a renal transplant and 130,261 had died without receiving such. Compared with white patients, the adjusted likelihood of receiving a transplant for indigenous patients was significantly lower in Australia (hazard ratio (HR) 0.23), Canada (HR 0.34), New Zealand (HR 0.23), and the United States (HR 0.44). In all four countries, indigenous patients had significantly longer overall median waiting times compared to white patients. Our study shows that despite marked differences in health care delivery systems, indigenous patients are less likely than white patients to receive a renal transplant in these countries. Understanding and addressing barriers to renal transplantation of indigenous patients remains an important concern.
</p>
  a1523-1755 (Electronic)0085-2538 (Linking)