1. ¹Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
2. ²Division of Critical Care Medicine. University of Alberta, Edmonton, Alberta, Canada
3. ³Institute of Health Economics, Edmonton, Alberta, Canada
4. ⁴Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
5. ⁵Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
6. ⁶Division of Nephrology. Department of Medicine, Division of Nephrology. University of Calgary, Calgary, Alberta, Canada
7. ⁷Department of Geography, University of Calgary, Calgary, Alberta, Canada
8. ⁸Division of Nephrology, St Paul's Hospital, Vancouver, British Columbia, Canada
9. ⁹Division of Nephrology, Tufts-New England Medical Center, Boston, Massachusetts, USA

Correspondence: M Tonelli, Division of Nephrology and Immunology, University of Alberta, 7-129 Clinical Science Building, 8440 112 Street, Edmonton, Alberta T6B 2B7, Canada. E-mail: mtonelli@ualberta.ca

Received 27 January 2006; Revised 19 April 2006; Accepted 27 April 2006; Published online 21 June 2006.

Abstract

For reasons that are not well understood, Aboriginal people with end-stage renal disease (ESRD) have lower rates of kidney transplantation. We hypothesized that distance between residence location and the closest transplant center was greater in Aboriginal dialysis patients and would partially explain the lower rate of transplantation in this population. We studied a random sample of 9905 patients initiating dialysis in Canada between 1990 and 2000. We calculated the distance between residence location at dialysis inception and the closest transplant center. Cox proportional hazards models were used to examine the relation between residence location and the likelihood of transplantation over a median period of 2.3 years. The proportion of Aboriginal participants living 50, 50.1–150, 150.1–300, and >300 km from the closest transplant center was 25, 18, 18, and 39% respectively, compared with 55, 19, 11, and 15% among white subjects. The relative likelihood of transplantation was significantly lower for Aboriginal compared to white participants across all four distance strata, with no apparent effect of residence location. For example, the relative likelihood of transplantation was hazard ratio (HR) 0.47, 95% confidence interval (CI) (0.31–0.72) in Aboriginal participants residing 50 and 0.55 (0.38–0.80) in those residing >300 km from the closest transplant center. Results were similar for transplants from deceased donors and living donors, and in all seven regions studied. In conclusion, remote location of residence does not explain the lower rate of kidney transplantation among Aboriginal people treated for ESRD in Canada.