Examining Inequities in Clinical Outcomes for Indigenous Patients Treated With Dialysis in Canada: A Scoping Review

The burden of kidney disease among Indigenous peoples in Canada is disproportionately higher than the rest of the population. We aimed to synthesize the existing knowledge on the clinical outcomes among Indigenous peoples treated with dialysis in Canada. We searched MEDLINE, Embase, CINAHL, Scopus, Web of Science Core Collection, and the Bibliography of Indigenous Peoples of North America, supplemented by a gray literature review. The following inclusion criteria were used: (1) studies assessing dialysis patients, (2) including Canadian Indigenous patients, and (3) relating to incidence, mortality, treatment complications, access to care, and/or quality of life. Forty-four studies, conducted across multiple Canadian provinces, were included. Fifteen studies highlighted the higher prevalence of diabetic and nondiabetic kidney failure among Indigenous Canadians compared with non-Indigenous Canadians. Indigenous patients experienced more frequent dialysis-related infections and cardiovascular complications, increased hospitalization rates, lower rates of arteriovenous fistula creation, lower use of home dialysis, reduced access to health care services, and decreased quality of life because of relocation for dialysis. Few studies explored the underlying causes of the observed inequities. Our findings underscore the need to better understand the contributing factors to develop culturally appropriate interventions, codesigned with Indigenous communities, that promote equitable care for Indigenous patients receiving dialysis.