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Dialysis outcomes of elderly I ndigenous and non‐ I ndigenous A ustralians
Author(s) -
McKercher Charlotte,
Chan Hoi Wong,
Clayton Philip A,
McDonald Stephen,
Jose Matthew D
Publication year - 2014
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12317
Subject(s) - medicine , indigenous , hazard ratio , interquartile range , dialysis , proportional hazards model , retrospective cohort study , referral , peritoneal dialysis , confidence interval , demography , family medicine , ecology , sociology , biology
Aim Whilst increasing numbers of elderly people in A ustralia are commencing dialysis, few Indigenous patients are aged ≥65 years and their outcomes are unknown. We compared the long‐term survival, mortality hazards and causes of death between elderly Indigenous and elderly non‐Indigenous dialysis patients. Methods This was a retrospective cohort study of adults aged ≥65 years who commenced dialysis in A ustralia from 2001–2011, identified from the A ustralia and N ew Z ealand D ialysis and T ransplant ( ANZDATA ) Registry. Indigenous ( n = 263) and non‐Indigenous ( n = 10713) patients were followed until death, loss to follow‐up, recovery of renal function or 31 D ecember 2011. Mortality was compared using a multivariate C ox proportional‐hazards model with age, gender, body mass index, smoking, primary renal disease, comorbidities, late referral and initial treatment modality as predictive variables. Results Median follow‐up was 26.9 months (interquartile range 11.3–48.8 months). Overall 166 Indigenous and 6265 non‐Indigenous patients died during the 11‐year follow‐up period. Mortality rates per 100 patient‐years were 23.9 for Indigenous patients and 21.2 for non‐Indigenous patients. The overall 1‐, 3‐ and 5‐year survival rates were 81%, 49% and 27% for Indigenous patients and 82%, 55% and 35% for non‐Indigenous patients respectively. Indigenous patients had a 20% increased risk of mortality compared with non‐Indigenous patients (adjusted hazard ratio 1.20, 95% confidence interval, 1.02, 1.41; P = 0.02). ‘Social deaths’ (predominantly dialysis withdrawal) and cardiac deaths were the main causes of death for both groups. Conclusion Among elderly dialysis patients in A ustralia, Indigenous status remains an important factor in predicting survival.