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Open Access Research article

Young aboriginals are less likely to receive a renal transplant: a Canadian national study

Steven Promislow1, Brenda Hemmelgarn2, Claudio Rigatto3, Navdeep Tangri3, Paul Komenda3, Leroy Storsley4, Karen Yeates5, Julie Mojica4 and Manish M Sood1*

Author Affiliations

1 Department of Medicine, Section of Nephrology, St Boniface Hospital, University of Manitoba, 409 Tache Avenue, Winnipeg, R2H 2A6, Canada

2 Department of Medicine, Section of Nephrology, Foothills Hospital, University of Calgary, 1403 29 Street, Calgary, AL, T2N2T9, Canada

3 Department of Medicine, Section of Nephrology, Seven Oaks Hospital, University of Manitoba, 2300 McPhillips Street, Winnipeg, R2V 3M3, Canada

4 Department of Medicine, Section of Nephrology, Health Sciences Centre, University of Manitoba, 820 Sherbrook street, Winnipeg, MB, R3A 1R9, Canada

5 Department of Medicine, Section of Nephrology, Kingston General Hospital, Queen’s University, 94 Stuart Street, Kingston, ON, K7L2V6, Canada

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BMC Nephrology 2013, 14:11  doi:10.1186/1471-2369-14-11

Published: 14 January 2013

Abstract

Background

Previous studies have demonstrated Aboriginals are less likely to receive a renal transplant in comparison to Caucasians however whether this applies to the entire population or specific subsets remains unclear. We examined the effect of age on renal transplantation in Aboriginals.

Methods

Data on 30,688 dialysis (Aboriginal 2,361, Caucasian 28, 327) patients obtained between Jan. 2000 and Dec. 2009 were included in the final analysis. Racial status was self-reported. Cox proportional hazards, the Fine and Grey sub-distribution method and Poisson regression were used to determine the association between race, age and transplantation.

Results

In comparison to Caucasians, Aboriginals were less likely to receive a renal transplant (Adjusted HR 0.66 95% CI 0.57-0.77, P < 0.0001) however after stratification by age and treating death as a competing outcome, the effect was more predominant in younger Aboriginals (Age 18–40: 20.6% aboriginals vs. 48.3% Caucasians transplanted; aHR 0.50(0.39-0.61), p < 0.0001, Age 41–50: 10.2% aboriginals vs. 33.9% Caucasians transplanted; aHR 0.46(0.32-0.64), p = 0.005, Age 51–60: 8.2% aboriginals vs. 19.5% Caucasians transplanted; aHR0.65(0.49-0.88), p = 0.01, Age >60: 2.7% aboriginals vs. 2.6% Caucasians transplanted; aHR 1.21(0.76-1.91), P = 0.4, Age X race interaction p < 0.0001). Both living and deceased donor transplants were lower in Aboriginals under the age of 60 compared to Caucasians.

Conclusion

Younger Aboriginals are less likely to receive a renal transplant compared to their Caucasian counterparts, even after adjustment for comorbidity. Determination of the reasons behind these discrepancies and interventions specifically targeting the Aboriginal population are warranted.