Dialysis outcomes of elderly Indigenous and non-Indigenous Australians

Nephrology (Carlton). 2014 Oct;19(10):610-6. doi: 10.1111/nep.12317.


Aim: Whilst increasing numbers of elderly people in Australia 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 Australia from 2001-2011, identified from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Indigenous (n = 263) and non-Indigenous (n = 10,713) patients were followed until death, loss to follow-up, recovery of renal function or 31 December 2011. Mortality was compared using a multivariate Cox 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 Australia, Indigenous status remains an important factor in predicting survival.

Keywords: dialysis; end-stage kidney disease; epidemiology; high risk populations.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Australia / epidemiology
  • Cause of Death
  • Chi-Square Distribution
  • Comorbidity
  • Female
  • Heart Diseases / ethnology
  • Heart Diseases / mortality
  • Humans
  • Kaplan-Meier Estimate
  • Kidney / physiopathology
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / ethnology
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / physiopathology
  • Kidney Failure, Chronic / therapy*
  • Male
  • Multivariate Analysis
  • Native Hawaiian or Other Pacific Islander*
  • Proportional Hazards Models
  • Recovery of Function
  • Registries
  • Renal Dialysis* / adverse effects
  • Renal Dialysis* / mortality
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Withholding Treatment