Survival of Indigenous Australians receiving renal replacement therapy: closing the gap?

<p><strong>Objectives:</strong> To compare mortality rates for Indigenous and non-Indigenous Australians commencing renal replacement therapy (RRT) over time and by categories of remoteness of place of residence.</p> <p><strong>Design</strong><strong>, setting and participants</strong><strong>:</strong> An observational cohort study of Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data on Indigenous and non-Indigenous Australians registered with ANZDATA who commenced RRT from 1 January 1995 to 31 December 2009 and were followed until 31 December 2011.</p> <p><strong>Main outcome measures:</strong> Five-year all-cause mortality for Indigenous and non-Indigenous patients in three cohorts (1995–1999, 2000–2004 and 2005–2009) and five remoteness (of place of residence) categories. </p> <p><strong>Results:</strong> Indigenous patients were younger, more likely to have diabetes, be referred late and be from a more remote area than non-Indigenous patients. Age and comorbid conditions increased with successive cohorts for both groups. Unadjusted analysis (using the log-rank test) showed an increased risk of death for Indigenous patients in the 1995–1999 (<em>P</em> = 0.02) and 2000–2004 (<em>P</em> = 0.03) cohorts, but not for the 2005–2009 cohort (<em>P</em> = 0.7). However, a Cox proportional hazards model adjusted for covariates (age, sex, late referral and comorbid conditions [diabetes, coronary artery disease, peripheral vascular disease, cerebrovascular disease, lung disease], and body mass index < 18.5 kg/m² and > 30 kg/m²) showed the following Indigenous:non-Indigenous hazard ratios (with 95% CIs) for major capital cities: 1995–1999, 1.47 (1.21–1.79); 2000–2004, 1.35 (1.12–1.63); and 2005–2009, 1.37 (1.14–1.66).</p> <p><strong>Conclusions:</strong> Although unadjusted analysis suggests that the survival gap between Indigenous and non-Indigenous patients receiving RRT has closed, there remains a significant disparity in survival after adjusting for the variables considered in our study.</p>