Adverse outcomes among Aboriginal patients receiving peritoneal dialysis

Sood, Manish M.; Komenda, Paul; Sood, Amy R.; Reslerova, Martina; Verrelli, Mauro; Sathianathan, Chris; Eng, Loretta; Eng, Amanda; Rigatto, Claudio

doi:10.1503/cmaj.100105

Cited by 26 publications

(41 citation statements)

References 30 publications

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“…Our findings suggest that a racial ethnic disparity may exist for survival on peritoneal dialysis for Aboriginals in Canada. Previous literature has shown conflicting results on peritoneal dialysis and mortality in Aboriginals (10,12,14,15,17). Our findings are consistent with a recent report from Manitoba, where we investigated 161 Aboriginal patients compared with 566 non-Aboriginal patients on peritoneal dialysis and found an increase in mortality (adjusted HR=1.48, 95% CI=1.07-2.03) and peritonitis (adjusted HR=1.79, 95% CI=1.35-2.36) among Aboriginals (10,17).…”

Section: Discussionsupporting

confidence: 89%

“…However, this finding is in direct contrast to some findings from Australia and New Zealand, where Aboriginals on peritoneal dialysis have worse outcomes with an increased risk of peritonitis, technique failure, hospitalizations, and mortality (14)(15)(16). Recently, we have also reported an increase in peritonitis and mortality rates in Aboriginals relative to Caucasians undergoing peritoneal dialysis in Manitoba, Canada (10,17). Whether these differences are caused by differences in patient's characteristics, methods of care delivery, or study design remains unknown.…”

Section: Introductioncontrasting

confidence: 88%

“…Although home dialysis modalities such as peritoneal dialysis may be considered optimal for the Aboriginal population living in remote locations, concerns regarding potential differences in survival by dialysis modality have been raised (10).…”

Section: Introductionmentioning

confidence: 99%

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Association of Modality with Mortality among Canadian Aboriginals

Sood

Hemmelgarn

Rigatto

et al. 2012

Clinical Journal of the American Society of Nephrology

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Summary Background and objectives Previous studies have shown that Aboriginals and Caucasians experience similar outcome on dialysis in Canada. Using the Canadian Organ Replacement Registry, this study examined whether dialysis modality (peritoneal or hemodialysis) impacted mortality in Aboriginal patients. Design, setting, participants, & measurements This study identified 31,576 adult patients (hemodialysis: Aboriginal=1839, Caucasian=21,430; peritoneal dialysis: Aboriginal=554, Caucasian=6769) who initiated dialysis between January of 2000 and December of 2009. Aboriginal status was identified by self-report. Dialysis modality was determined 90 days after dialysis initiation. Multivariate Cox proportional hazards and competing risk models were constructed to determine the association between race and mortality by dialysis modality. Results During the study period, 939 (51.1%) Aboriginals and 12,798 (53.3%) Caucasians initiating hemodialysis died, whereas 166 (30.0%) and 2037 (30.1%), respectively, initiating peritoneal dialysis died. Compared with Caucasians, Aboriginals on hemodialysis had a comparable risk of mortality (adjusted hazards ratio=1.04, 95% confidence interval=0.96–1.11, P=0.37). However, on peritoneal dialysis, Aboriginals experienced a higher risk of mortality (adjusted hazards ratio=1.36, 95% confidence interval=1.13–1.62, P=0.001) and technique failure (adjusted hazards ratio=1.29, 95% confidence interval=1.03–1.60, P=0.03) than Caucasians. The risk of technique failure varied by patient age, with younger Aboriginals (<50 years old) more likely to develop technique failure than Caucasians (adjusted hazards ratio=1.76, 95% confidence interval=1.23–2.52, P=0.002). Conclusions Aboriginals on peritoneal dialysis experience higher mortality and technique failure relative to Caucasians. Reasons for this race disparity in peritoneal dialysis outcomes are unclear.

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Section: Discussionsupporting

confidence: 89%

Section: Introductioncontrasting

confidence: 88%

See 1 more Smart Citation

Association of Modality with Mortality among Canadian Aboriginals

Sood

Hemmelgarn

Rigatto

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…Because of our small cohort size and few endpoints, the multivariate models could account only for a limited number of variables. Lastly, Manitoba has a unique population with a high number of aboriginal PD patients who are often younger, have high rates of diabetes, and experience higher rates of peritonitis and mortality (20). Thus, our findings have limited generalizability and require confirmation in other cohorts.…”

Section: Discussionmentioning

confidence: 84%

High Rates of Mortality and Technique Failure in Peritoneal Dialysis Patients after Critical Illness

Khan¹,

Rigatto

Verrelli

et al. 2012

Perit Dial Int

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♦ Introduction: Little is known regarding the causes and outcomes of peritoneal dialysis (PD) patients admitted to the intensive care unit (ICU). We explored the outcomes of technique failure and mortality in a cohort of PD patients admitted to the ICU. ♦ Methods: Using a provincial database of 990 incident PD patients followed from January 1997 to June 2009, we identified 90 (9%) who were admitted to the ICU. Parametric and nonparametric tests were used as appropriate to determine differences in baseline characteristics. The Cox proportional hazards and competing risk methods were used to investigate associations. ♦ Results: Compared with other patients, those admitted to the ICU had been on PD longer (p < 0.0001) and were more often on continuous ambulatory PD (74.2% vs 25.8%, p = 0.016). Cardiac problems were the most common admitting diagnosis (50%), followed by sepsis (23%), with peritonitis accounting for 69% of the sepsis admissions. The 1-year mortality was 53.3%, with 12% alive and converted to hemodialysis, and one third remaining alive on PD. A s the steady worldwide rise in the peritoneal dialysis (PD) population continues, the requirements for and health resources consumed by this population rise in parallel. Today, PD patients are increasingly older, with lower functional status and a higher burden of comorbid illness (1-4). This situation has cumulated in a rise in critical illness and the need for admission to the intensive care unit (ICU) (5-7). Despite this escalation in ICU admission, little literature is available about the causes of critical illness, prognosis, or long-term outcomes to guide health care providers (8-18).The existing data seem to suggest that, in the dialysis population, admission to the ICU portends a poor prognosis. However, the situation is seemingly more complicated, because after accounting for comorbid illnesses and illness acuity upon admission to the ICU, end-stage renal disease (ESRD) patients have outcomes similar to those for non-ESRD patients. This suggests that ESRD is not per se responsible for an increase in poor outcomes such as death and length of ICU stay (5,6).To our knowledge, few studies have directly addressed the impact of dialysis modality on critical illness. One small study included 92 ESRD patients, 16 of whom were on PD (12). The PD patients experienced poor survival, having a 44% mortality compared with 25% in the hemodialysis (HD) cohort. Recent data collected by our group further strengthens the finding that dialysis modality may play a strong role in survival (19). Our group analyzed the long-term outcomes of 619 ESRD patients, 95 of whom were on PD; 334, on HD with a catheter; and 190, on HD with an arteriovenous fistula. Three different models accounting for case mix, comorbid illness, and physiologic variables found, as expected, that compared with HD patients having an arteriovenous fistula, HD patients with a catheter had an adjusted hazard ratio (HR) for death ranging from 1.50 to 1.58. What was unexpected and surprising was we also obser...

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“…The quality of these data is adjudicated at formal interprofessional rounds on a weekly basis. The validation of this database has been described elsewhere, 10 and the database has been used extensively in published epidemiologic studies.…”

Section: Manitoba Renal Program Dialysis Registrymentioning

confidence: 99%