Who Gets Access to Kidney Care?

Kidney disease makes health-system inequality unusually visible because treatment can depend on specialist expertise, repeated travel, dialysis infrastructure, reliable supplies, financing and access to transplantation. Two people with similar clinical need can therefore face very different pathways depending on where they live and how the system receives them.

Registry studies from Canada and comparative work across Australia, Canada, New Zealand and the United States documented substantially lower transplantation rates among Indigenous patients and other racialized groups even within publicly financed systems. Age-stratified analysis showed that the gap could be especially large among younger Indigenous adults. Other studies found that once transplantation occurred, some post-transplant outcomes were more similar than access rates suggested. Together, these findings move the research question upstream: inequity may emerge before surgery, in referral, evaluation, wait-listing, living donation, communication or institutional processes.

Low-resource kidney programmes add another dimension. Equity is also shaped by whether renal replacement therapy exists at all, whether patients are recognized early enough to reach it, and whether treatment can be sustained. Access is therefore a pathway, not one decision at the end.