{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T22:37:48Z","timestamp":1792190268250,"version":"4.4.0"},"reference-count":29,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T00:00:00Z","timestamp":1765152000000},"content-version":"unspecified","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,11,12]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Large differences exist in chronic kidney disease (CKD) rates between countries, but differences within diverse populations living in the same setting with universal healthcare are not well understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To compare dialysis prevalence, CKD risk factors and control, and CKD progression by ethnicity and birth country in an ethnoculturally diverse setting with high rates of kidney disease and universal healthcare.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Scarborough, Toronto\u2019s most diverse region and site of Canada\u2019s largest regional dialysis programme.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and participants<\/jats:title>\n                    <jats:p>Double observational cohort study of 2397 participants: a retrospective cohort of 1116 residents who received dialysis between 2016\u20132019, and a prospective cohort of 1281 individuals with non-dialysis CKD followed for 3 years between 2010\u20132015 in Scarborough.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measurements<\/jats:title>\n                    <jats:p>Dialysis prevalence, calculated by comparing frequencies of birth countries and ethnicities in the dialysis cohort with census-derived community frequencies. Secondary outcome measurements were traditional CKD risk factor prevalence (diabetes, hypertension, cardiovascular disease) and control (haemoglobin A1c, blood pressure); and CKD progression (estimated glomerular filtration rate decline, proteinuria) adjusted for socioeconomic status in the non-dialysis cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Dialysis prevalence was 4.2 times higher in immigrants (p&lt;0.001), and highest in those born in the Caribbean, Southeast Asia and South Asia. Ethnicity-based differences were smaller, with rates up to 1.7-fold higher in Southeast Asian, Black and South Asian compared with White persons. Diabetes prevalence was highest in immigrants from South Asia, Southeast Asia and the Caribbean. Blood pressure and haemoglobin A1c were higher in Caribbean-born individuals. Kidney function declined fastest in patients born in the Caribbean, South Asia and East Asia. Proteinuria increased most rapidly in patients born in the Caribbean, Southeast Asia and South Asia. The year of immigration did not influence these secondary outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite universal healthcare access, marked disparities in CKD risks and rates exist within ethnoculturally diverse immigrants living in this Canadian kidney disease hotspot. More focused research and tailored interventions are required.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-105083","type":"journal-article","created":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T09:00:23Z","timestamp":1765270823000},"page":"e105083","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Ethnic and immigrant disparities in dialysis prevalence and chronic kidney disease trajectories in Toronto"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct01974713","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5356-872X","authenticated-orcid":false,"given":"Tabo","family":"Sikaneta","sequence":"first","affiliation":[{"name":"Department of Research, Kidney Life Sciences Institute, Toronto, Ontario, Canada"},{"name":"Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Nephrology, Scarborough Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2659-8539","authenticated-orcid":false,"given":"Salome","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Scarborough Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4781-4699","authenticated-orcid":false,"given":"Istvan","family":"Mucsi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Multiorgan Transplant Program, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aisha K","family":"Lofters","sequence":"additional","affiliation":[{"name":"Family and Community Medicine, St. Michael\u2019s Hospital, Toronto, Ontario, Canada"},{"name":"Centre for Research on Inner City Health, Lika Shing Knowledge Institute, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8736-4779","authenticated-orcid":false,"given":"Hulya","family":"Taskapan","sequence":"additional","affiliation":[{"name":"Department of Research, Kidney Life Sciences Institute, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4905-1197","authenticated-orcid":false,"given":"Paul","family":"Tam","sequence":"additional","affiliation":[{"name":"Department of Research, Kidney Life Sciences Institute, Toronto, Ontario, Canada"},{"name":"Department of Nephrology, Scarborough Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4977-0431","authenticated-orcid":false,"given":"Sara","family":"Mahdavi","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Scarborough Health Network, Toronto, Ontario, Canada"},{"name":"Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Nutrition, Harvard University, Cambridge, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,12,8]]},"reference":[{"key":"2026010703461594000_15.12.e105083.1","doi-asserted-by":"publisher","DOI":"10.1038\/s41581-024-00820-6"},{"key":"2026010703461594000_15.12.e105083.2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.332.7541.563"},{"key":"2026010703461594000_15.12.e105083.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0272-6386(99)70035-1"},{"key":"2026010703461594000_15.12.e105083.4","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfu118"},{"key":"2026010703461594000_15.12.e105083.5","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/j.semnephrol.2019.02.009","article-title":"CKD Hotspots: Challenges and Areas of Opportunity","volume":"39","author":"Obrador","year":"2019","journal-title":"Semin Nephrol"},{"key":"2026010703461594000_15.12.e105083.6","doi-asserted-by":"crossref","DOI":"10.1186\/s12882-020-01852-3","article-title":"Ethnic minority disparities in progression and mortality of pre-dialysis chronic kidney disease: a systematic scoping review","volume":"21","author":"Hounkpatin","year":"2020","journal-title":"BMC Nephrol"},{"key":"2026010703461594000_15.12.e105083.7","unstructured":"Lalonde M . 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