Prevalence of Chronic Kidney Disease and Survival among Aboriginal People

Abstract

Globally, it is known that the incidence of end-stage renal disease is higher among Aboriginals, but it is unknown whether this is due to an increased prevalence of chronic kidney disease or other unidentified factors. We studied 658,664 people of non-First Nations and 14,989 people of First Nations and found that the age-and sex-adjusted prevalence of chronic kidney disease was significantly higher among those of non-First Nations compared to those of First Nations (67.5 versus 59.5 per 1000 population; P Ͻ 0.0001). However, severe chronic kidney disease (estimated glomerular filtration rate Ͻ30 ml/min per 1.73 m 2 ) was almost two-fold higher among people of First Nations (P Ͻ 0.0001). Cox proportional hazards models suggested that compared to people of non-First Nations, those of First Nations with chronic kidney disease had a 77% increased risk of death after adjusting for age, gender, diabetes and baseline eGFR. In conclusion, whether the higher incidence of end-stage renal disease among people of First Nations is due to suboptimal management of chronic kidney disease and its associated comorbidities, more rapid loss of kidney function, or other unidentified factors remains to be determined.

Differential mortality and the excess burden of end-stage renal disease among First Nations people with diabetes mellitus: a competing-risks analysis

“…15 This phenomenon occurs in the formerly perplexing context of higher age-adjusted mortality among First Nations individuals with diabetes. 8,16,17 It also explains our earlier observation that the time from diabetes diagnosis to end-stage renal disease is significantly longer among First Nations individuals, 2 despite evidence for poorer quality of diabetes care 18,19 and a larger proportion of patients with early diabetic nephropathy. 8,20 These findings are notable because they reveal an important mechanism underlying ethnicity-based disparities in endstage renal disease that has serious long-term implications for First Nations and other indigenous populations.…”

Progression of Kidney Disease in Indigenous Australians: The eGFR Follow-up Study

“…Although studies from the United States consistently report higher incidence of ESRD among ethnic minorities, data on more rapid progression of CKD in ethnic minorities in the United States are conflicting (15). Data on CKD progression rates among Canadian First Nation populations are limited, with recent findings suggesting faster progression of kidney dysfunction leading to high rates of ESRD in that population (16).…”

Association between First Nations ethnicity and progression to kidney failure by presence and severity of albuminuria

“…However, we have previously reported that First Nations people are as likely as non-First Nations people to obtain a measure of serum creatinine. 1 There is a potential for misclassification of albuminuria based on urine dipstick assessment, particularly when the measurement is based on a single measure. However, the percentage of participants with unmeasured proteinuria in our cohort is similar to that seen in other cohorts of patients with chronic kidney disease.…”