Disparity of access to kidney transplantation by indigenous and non-indigenous Australians

Namrata Khanal, Paul D. Lawton, Alan Cass, Stephen P. McDonald

    Research output: Contribution to journalArticleResearchpeer-review

    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.

    Original languageEnglish
    Pages (from-to)261-266
    Number of pages6
    JournalMedical Journal of Australia
    Volume209
    Issue number6
    DOIs
    Publication statusPublished - 17 Sep 2018

    Fingerprint

    Kidney Transplantation
    Renal Replacement Therapy
    Waiting Lists
    Transplantation
    New Zealand
    Chronic Kidney Failure
    Observational Studies
    Registries
    Dialysis
    Cohort Studies
    Outcome Assessment (Health Care)
    Tissue Donors
    Transplants

    Cite this

    @article{561fc31f8d894c0c8e79664c46ce3d73,
    title = "Disparity of access to kidney transplantation by indigenous and non-indigenous Australians",
    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.",
    author = "Namrata Khanal and Lawton, {Paul D.} and Alan Cass and McDonald, {Stephen P.}",
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    Disparity of access to kidney transplantation by indigenous and non-indigenous Australians. / Khanal, Namrata; Lawton, Paul D.; Cass, Alan; McDonald, Stephen P.

    In: Medical Journal of Australia, Vol. 209, No. 6, 17.09.2018, p. 261-266.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Disparity of access to kidney transplantation by indigenous and non-indigenous Australians

    AU - Khanal, Namrata

    AU - Lawton, Paul D.

    AU - Cass, Alan

    AU - McDonald, Stephen P.

    PY - 2018/9/17

    Y1 - 2018/9/17

    N2 - 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.

    AB - 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.

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    U2 - 10.5694/mja18.00304

    DO - 10.5694/mja18.00304

    M3 - Article

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    SP - 261

    EP - 266

    JO - Medical Journal of Australia

    JF - Medical Journal of Australia

    SN - 0025-729X

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    ER -