Aboriginal Canadians with chronic kidney disease may be twice as likely to be admitted to hospital for a potentially preventable condition compared with non-aboriginal people, researchers have found.

In Tuesday's issue of the Canadian Medical Association Journal, Dr. Brenda Hemmelgarn of the nephrology division at the University of Calgary and her colleagues in Calgary and Edmonton reported that status aboriginal people were 1.77 times more likely to be admitted for potentially preventable complications resulting from earlier inadequate access to care compared with non-aboriginals.

In chronic kidney disease, the kidneys slowly lose their ability to filter blood. Unlike with heart disease, where there may be symptoms such as chest pain, there are often no symptoms of kidney disease until its end stages, when dialysis or a transplant may be needed.

Hemmelgarn said that although anecdotally she had seen more aboriginal patients with late stage kidney disease, when death rates are higher, she was surprised to find that aboriginal patients were more likely to be admitted for preventable complications.

"Given the increased mortality among patients with a late referral to a nephrologist, these results suggest suboptimal quality of care in the aboriginal population and the need for interventions to reduce or eliminate these disparities," Hemmelgarn said.

After adjusting for average household income and rural residence, aboriginal people were still 50 per cent more likely to be admitted for a condition normally treated on an outpatient basis.

'Locked door' of specialists

Aboriginal people with severe kidney disease were also 43 per cent less likely to than non-aboriginal people with the same degree of kidney disease to visit a nephrologist, the researchers found, based on their analysis of records from more than 106,500 non-aboriginals and 1,182 aboriginal patients with chronic kidney disease in Alberta.

The study documents that aboriginal Canadians have less access to preventive care and specialists, a finding that shows the medical community needs to "raise the bar" to prevent life-threatening complications, said nephrologist Dr. Karen Yeates of Queen's University in Kingston, who was not involved in conducting the study.

To close the gaps in access to gap and outcomes that have been documented for indigenous people in Canada, Australia, New Zealand and the U.S., researchers need to document the disparities and understand the causes more precisely to make collaborative changes, Dr. Alan Cass of the George Institute for International Health in Sydney said in journal commentary accompanying the study.

"Such changes are often resisted by institutional, political, structural, social and cultural forces," Cass and his fellow commentators wrote.

The commentary quoted an Aboriginal man with end-stage kidney disease who was interviewed for a study on improving access to kidney transplants in Australia: "You don’t go knocking on their door, [that's the] 'danger one.' The door is locked. They sit behind closed doors," he said, referring to communication with kidney specialists.

"If we are able to open these doors, our health-care systems may perform better for the most vulnerable," the commentary concluded.