Disparity of access to kidney transplantation by Indigenous and non‐Indigenous Australians. Issue 6 (17th September 2018)

• Record Type: Journal Article
• Authors: Khanal, Namrata; Lawton, Paul D; Cass, Alan; McDonald, Stephen P
• Is Part Of: Medical journal of Australia. Volume 209:Issue 6(2018)
• Page Start: 261
• Page End: 266
• Publication Date: 2018-09-17
• Subjects: Urologic diseases -- Indigenous health; Medicine -- Periodicals; Medicine; Médecine -- Périodiques; Medicine; Periodical; Periodicals; Electronic journals; 610
• DOI: 10.5694/mja18.00304
• Languages: English
• ISSNs: 0025-729X

Abstract

Abstract: Objective: To compare the likelihood of Indigenous and non‐Indigenous Australians being placed on the waiting list for transplantation of a kidney from a deceased donor; to compare the subsequent likelihood of transplantation. Design, setting and participants: Observational cohort study; analysis of data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry for patients aged 18–60 years at the start of renal replacement therapy, who commenced renal replacement therapy in Australia between 28 June 2006 and 31 December 2016. Main outcome measures: Time to wait‐listing; time to kidney transplantation after wait‐listing. Results: 10 839 patients met the inclusion criteria, of whom 2039 (19%) were Indigenous Australians; 217 Indigenous and 3829 non‐Indigenous patients were active on the waiting list at least once during the study period. The hazard ratio (HR) for wait‐listing (Indigenous v non‐Indigenous patients, adjusted for patient‐ and disease‐related factors) in the first year of renal replacement therapy varied with age and remoteness (range, 0.11 [95% CI, 0.07–0.15] to 0.36 [95% CI, 0.16–0.56]); in subsequent years the adjusted HR was 0.90 (95% CI, 0.50–1.6). The adjusted HR for transplantation during the first year of wait‐listing did not differ significantly from 1.0; for subsequent years of wait‐listing, however, the adjusted HR was 0.40 (95% CI, 0.29–0.55). Conclusion: Disparities between Indigenous and non‐Indigenous patients with end‐stage kidney disease in access to kidney transplantation are not explained by patient‐ or disease‐related factors. Changes in policy and practice are needed to reduce these differences.