1. ¹Department of Medicine, Queen's University, Kingston, Canada
2. ²Renal Division, George Institute for International Health, Sydney, Australia
3. ³Poche Centre for Indigenous Health, University of Sydney, Sydney, Australia
4. ⁴Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
5. ⁵Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
6. ⁶Harvard Vanguard Medical Associates, Newton, Massachusetts, USA
7. ⁷Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia
8. ⁸Canadian Institute for Health Information, Toronto, Canada
9. ⁹Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA

Correspondence: Karen E Yeates, Department of Medicine, Division of Nephrology, Etherington Hall, 94 Stuart Street, Queen's University, Kingston, Canada. E-mail: yeatesk@queensu.ca

Received 28 January 2009; Revised 7 May 2009; Accepted 13 May 2009; Published online 24 June 2009.

Abstract

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.