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International Scientific Indexing (ISI) Indexed Journal Applied Medical Research ISSN: 2149 - 2018
Applied Medical Research. 2021; 8(2):(118-159)

Characteristics of End-Stage Kidney Disease in a Cohort of Indigenous and Non-Indigenous Adults in Northwestern Ontario, Canada

Victoria Domonkos, William G. McCready and Marina Ulanova*

Background: In Canada, the prevalence of chronic kidney disease is two-fold higher among Indigenous than non-Indigenous people. Direct comparisons of clinical characteristics between Indigenous and non- Indigenous end-stage kidney disease (ESKD) patients have not been previously conducted. We compared demographic and clinical characteristics of Indigenous and non-Indigenous adults with ESKD receiving dialysis at the primary hospital serving a region with 20% Indigenous population. Methods: During 4 years, 186 adults with ESKD were recruited for a clinical trial to analyze the response to pneumococcal immunization. Demographic and clinical data, including age, sex, residency, dialysis characteristics, etiology for chronic kidney disease, comorbidities, history of infections and prior pneumococcal immunization were compared between 91 Indigenous and 94 non-Indigenous individuals. Results: Indigenous participants were significantly younger than non-Indigenous, both at the time of the study and initiation of dialysis; they had a longer history of dialysis and lower vaccination rates with the recommended pneumococcal vaccine. The most prevalent cause of the disease was diabetes, with a higher prevalence of type 2 diabetes among Indigenous than non-Indigenous. Glomerulonephritis was also more common among Indigenous participants due to a higher prevalence of IgA nephropathy. Renal vascular, chronic heart, joint diseases, and malignancies were more common among non-Indigenous participants. Conclusions: Indigenous individuals were greatly overrepresented among adults with ESKD receiving dialysis, with a younger age of disease onset and a more severe disease course. Despite a recognized risk of pneumococcal disease, adults with ESKD were under-immunized with the recommended pneumococcal vaccine, with the lowest immunization rates among Indigenous individuals.