Higher Risk of Infection and Death in First Nations People on Peritoneal Dialysi

[TRB]

ScienceDaily (July 26, 2010) — First Nations people in Canada on peritoneal dialysis are at increased risk of peritonitis and death, irrespective of whether they live in a rural or urban location, found a study published in CMAJ (Canadian Medical Association Journal).

The high prevalence of diabetes, obesity and hypertension in Canada's First Nations, or aboriginal, population is fuelling the rapid growth of kidney disease and renal failure and consequent need for care and dialysis.

Peritonitis is inflammation of the peritoneum (the inner lining of the abdominal and pelvic walls), often caused by infection.

Peritoneal dialysis (PD) uses the peritoneum through which to filter wastes and excess water compared with hemodialysis which filters these externally through a filter. Hemodialysis requires living close to a dialysis centre whereas peritoneal dialysis can be conducted by patients at home. In Canada, approximately 18% of dialysis patients are on peritoneal dialysis.

The study, by researchers from St. Boniface General Hospital and the University of Manitoba in Winnipeg, Manitoba, looked at 727 adults with end stage renal disease on peritoneal dialysis from 1997 to 2007 in Manitoba. Of this total, 161 were First Nations and 566 non-First Nations.

"In this large cohort of peritoneal dialysis patients, First Nations status was associated with an increase in mortality and peritonitis after adjusting for baseline demographics, co-morbidities and peritoneal characteristics, and these findings were independent of residing in an urban or rural environment," writes Dr. Manish Sood with coauthors.

The authors suggest that the increase in mortality may be due to dialysis clearance, with underlying inflammation and failure to clear fluid, although they stress this needs to be investigated.

They note that while geographic isolation and distance from health care can be associated with increased risk of death in people on dialysis, there was no difference between urban and rural First Nations patients on peritoneal dialysis.

"As many First Nations people live in the remote north, it was reassuring that patients far from their health care providers did no worse then those closer," write the authors. "Many patients, after experiencing kidney failure and initiating dialysis, relocate to cities which isolates them from family, culture and community. Our findings suggest there is no need to relocate patients."

More research into improving outcomes for First Nations dialysis patients is needed.

[Tonto]

Articles like this really annoy me!  Not the article itself, but how they say "Hemodialysis requires living close to a dialysis centre whereas peritoneal dialysis can be conducted by patients at home"

NOT TRUE!!!

It's great that they are bringing issues to the fore but I really with they'd get their facts straight.

[natnnnat]

This is very like articles I've seen about indigenous Australians.  For example,

From Radio National, (part of the ABC, Australia's national broadcaster)
Malpa Project
Sunday, 2 May 2010 12:00 AM
Chronic kidney disease is a common and serious problem in Australia. Where it's most common, though, is among Indigenous Australians. In Alice Springs right now there are hundreds of traditional Aboriginal people from communities throughout central Australia who are on, or are about to start, dialysis treatment. One of those is the Western Desert artist Norah Nelson Napaltjarri. Norah's best known for her Milky Way Dreaming paintings—if you've ever been to the Supreme Court in Darwin, there's a mosaic of one of those paintings of hers on the floor there. Norah's been on dialysis for ten years.

As part of something called the Malpa Project, Norah Nelson Napaltjarri organised some other Central Australian Indigenous artists to paint their dreaming stories on dialysis machines. The Malpa Project is run through Transplant Australia, and Don Palmer is the project director and he's speaking to Amanda Smith.

http://www.abc.net.au/rn/artworks/stories/2010/2886851.htm
this is the link if you are interested in listening to the story, it’s the first segment in a three segment show, starts about a minute into the audio.
Note that Radio National moves their stories after about three weeks, with apologies to the moderators....  Its still there today though, I checked.

I was very sad because I knew that there is a very high proportion of the indigenous population on dialysis, but I didn’t realise their chances of receiving a transplant are so low.  In the program Don says that there are only about 200 kidney transplants a year in Australia and most of them are from live donors giving to their loved ones.  And because aborigines are so likely to get CKD, they are unlikely to be approved as kidney donors.

I also found a PDF about it here http://www.transplant.org.au/IgnitionSuite/uploads/docs/Malpa%20Article.pdf
Which has lovely full colour photos of the painted dialysis machines...
(2009). "Art for Health's sake." PH(Dec 2009): 38-40.

[P8tience]

Yes I know from family history that Native Americans, aw heck lets say it, Indians, indigenous what ever... are more susceptible to kidney disease through diabetes, and hypertension. My grandmother had diabetes1, I have it as well and a few others in my family as well.  They are also doing a study on Native Americans and Pulmonary Hypertension.

My own take on this is...
Strangers came and introduced new and different eating styles.  This new and most likely different diet changed the metabolism causing disease and such. After all it is widely known that Native Americans should not drink alcohol.  Most of the time I say it is a stereotype, but it has direct correlation to diabetes and heart disease in Native Americans.