1. ¹Department 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. ⁵Division of Nephrology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
6. ⁶Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
7. ⁷Division of Nephrology, St Paul's Hospital, Vancouver, British Columbia, Canada
8. ⁸Division of Nephrology, Tufts-New England Medical Centre, Boston, Massachusetts, USA

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

Received 12 January 2007; Revised 25 April 2007; Accepted 1 May 2007; Published online 6 June 2007.

Abstract

Kidney failure is relatively common among Canadians of Asian origin. However, little is known about the health outcomes after initiation of renal replacement therapy in this population. Our study evaluates differences in the likelihood of renal transplantation and graft loss among Asian and white patients. We studied 21 523 adults of East Asian, Indo Asian or white ethnicity who had initiated dialysis in Canada from 1990–2000. Subjects were followed until death, loss to follow-up or end of study (2004). The proportion of the eligible subjects who were East Asian, Indo Asian, or white was 6, 3, and 91%, respectively. Compared to white patients, East Asian and Indo Asian patients were significantly less likely to receive a renal transplant after adjusting for potential confounding factors. This disparity is greater for transplants from living donors as compared to those from deceased donors. The adjusted death censored graft loss in transplant recipients was not significantly different between ethnic groups. The adjusted risk of death following transplantation, however, was significantly lower in Indo Asian than in white patients. Our findings show that in a Canadian population, patients of East Asian or Indo Asian origin had lower rates of renal transplantation than white patients, especially for living donor transplantation. These findings warrant further study, especially given the good graft outcomes in these individuals.