Dialysis for the Treatment of End Stage Kidney Disease in Indigenous Patients in Canada: A Review of Clinical Effectiveness
( Last Updated : December 6, 2016)
Health Technology Review
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Peer-reviewed Summary with Critical Appraisal
What is the clinical effectiveness of in-centre hemodialysis, in-centre self-care hemodialysis, home hemodialysis, and home peritoneal dialysis for the treatment of end stage kidney disease in Indigenous patients in Canada?
In general, Indigenous patients in the included studies tended to be younger, have more comorbidities (particularly diabetes mellitus), and were more likely to be female than their white and non-Indigenous counterparts. Although Indigenous patients tended to have higher mortality rates, when adjusted for age and comorbidities, of the five studies reporting mortality rates, only one (examining patients on PD) found statistically significant greater mortality rates in Indigenous patients than white patients. Indigenous patients seem less likely to initiate PD. Those who do initiate PD have greater rates of technique failure that require a switch to HD, and have higher rates of and are quicker to experience episodes of peritonitis than their non-Indigenous counterparts. Indigenous patients are also less likely to receive a kidney transplant. Telehealth follow-up of dialysis therapy can be successfully delivered to Indigenous patients in remote communities and was not shown to have a negative impact on mortality, quality of care, or healthcare utilization. Further culturally appropriate investigation regarding CKD screening and prevention, education initiatives, culturally appropriate care initiatives, and the reasons Indigenous patients seem to have higher rates of technique failure and lower PD use is important going forward. Further investigation is also warranted to determine the reasons Indigenous Canadians have lower rates of kidney transplantation.