Overview of replacement therapy in Indigenous compared to non-Indigenous Australians

Introduction: Indigenous Australians make up 3% of the total Australian population and comprised approximately 10% of new patients beginning renal replacement for end-stage kidney disease (ESKD) in Australia at the end of 2012. There are considerable differences in other health outcomes for indigenous Australians, including higher rates of cardiovascular disease, infection, diabetes and trauma. In this study we analyze the difference in overall patient characteristics, incidence and prevalence of different modalities of dialysis and patient survival in two groups- indigenous Australians.

Methods: We analyze data in the ANZDATA registry from Jan 2002 to Dec 2012. All adults (≥18years) who started renal replacement in Australia during the study period are included. Study cohort is divided in two categories depending on their ethnicity as described above: ATSI and non-ATSI. Patient survival on dialysis is calculated using Kaplan-Meier and Cox regression models, with followup censored at first transplant, recovery of renal function or loss to follow up. Statistical analysis is done using Stata version 13.1.

Results: Baseline characteristics: There are 2364 ATSI out of 24822 (9.5%) patients in the study cohort. There is female predominance (54.9%) in the ATSI group (p<0.001) while reverse is true for non-ATSI (male 62.3%). 35.9% ATSI have body mass index >30 kg/m2 and 28.6% of non-ATSI are in this category. Table1 shows the odds ratio of comorbidities in ATSI unadjusted and adjusted for age and gender.

Conclusions: Among ATSI, female patients make up relatively larger proportion of this group. Obesity and comorbidities except type1 diabetes are more frequent in ATSI patients. Use of home based therapies among ATSI is less compared to non-ATSI. Adjusted patient survival for this group is slightly worse. The factors underlying this are not known, but may include residual (unmeasured) confounders, including other comorbidities and remoteness and access to services.