Racial Disparities in Kidney Failure Among Black People in Ontario: A Population-Based Study

Background Ontario recently designated Black people aged 40 and older as a high-risk group for annual chronic kidney disease (CKD) screening in primary care, yet population-level data have been limited. Objective To describe and compare kidney failure incidence, prevalence, pre-dialysis care, treatment modality, and mortality between Black and White individuals in Ontario. Design Population-based descriptive analysis of provincial administrative health data, 2017–2024. Setting All adult kidney programs in Ontario, Canada, captured in the Ontario Renal Reporting System. Patients and Measurements All individuals receiving maintenance dialysis were included. Age-standardized rates of dialysis initiation, prevalence, and mortality were compared between Black and White individuals. Time from first meeting advanced CKD care lab criteria (eGFR <15 mL/min/1.73 m 2 or 2-year kidney failure risk ≥10%) to dialysis initiation and home dialysis uptake were compared. Results Among 26,042 incident dialysis patients, 1,674 (6.4%) were Black and 15,888 (61.0%) White. Black individuals were younger at initiation (median 62.0 vs. 69.9 years) with lower eGFR (6.7 vs. 8.3 mL/min/1.73 m 2 ). In 2024, age-standardized incidence of dialysis initiation among Black individuals was 1.8-fold higher (292.1 vs. 162.4 per million) and prevalence was 3.5-fold higher. Among those meeting advanced CKD care lab criteria, Black individuals had a shorter median interval to dialysis (593 vs. 666 days) and lower home dialysis uptake (18.8% vs. 24.1%). Age-standardized mortality was lower. Limitations Self-reported racialized identity was ascertained from administrative data and has not been formally validated, with a rising proportion recorded as “unknown” (19.6% by 2024); mortality and modality comparisons were standardized for age but not comorbidity; kidney transplantation was not assessed; and all analyses were restricted to individuals who reached maintenance dialysis. Conclusions Black individuals in Ontario experience higher kidney failure rates, begin dialysis younger with more advanced disease, and progress more rapidly from advanced CKD care to dialysis. These findings support Ontario’s recent recommendation of annual CKD screening for Black individuals aged 40 and older in primary care and underscore the need for earlier detection and intervention.