The rate of CKD is 3-fold higher among NZ Māori than among NZ non-Māori, non-Pacific peoples. Moreover, Māori commence dialysis treatment for ESRD at 3 times the rate of NZ European adults. This retrospective analysis was informed by a Kaupapa Māori approach and sought to determine evidence of inequity in dialysis-related incidence, treatment practices, and survival according to indigeneity in NZ, in a cohort of adults who commenced treatment for ESRD in NZ between 2002 and 2011. Propensity score matching assembled 1,039 Māori patients and 1,026 non-Māori patients matched by clinical and sociodemographic characteristics. Non-Māori were older, more likely to live in urban areas (83% vs 67%) and were less socioeconomically deprived (36% living in highest decile areas vs 14%) than Māori. Fewer non-Māori had diabetes (35% vs 69%) as a cause of kidney failure. Non-Māori were more frequently treated with peritoneal dialysis (34% vs 29%), received a pre-emptive kidney transplant (4% vs 1%), and were referred to specialist care <3 months before treatment (25% vs 19%). Fewer non-Māori started dialysis with a non-tunnelled dialysis vascular catheter (43% vs 47%). The Indigenous-age standardised incidence rate ratio for non-Māori commencing renal replacement therapy in 2011 was 0.50 (95% CI, 0.40 to 0.61) compared with Māori. Propensity score matching generated cohorts with similar characteristics, although non-Māori less frequently started dialysis with a non-tunnelled venous catheter (30% vs 47%) or lived remotely (3% vs 14%). In matched cohorts, non-Māori experienced lower all-cause mortality at 5 years after commencement of treatment (RR 0.78; 95% CI, 0.72 to 0.84). NZ European patients experienced lower mortality than Māori patients in indigenous age-standardised analyses (age-standardised mortality rate ratio 0.58).
