Optimisation during transition to dialysis commencement

The elimination of health disparities, as disproportionately experienced by Aboriginal and Torres Strait Islander peoples, is a central tenet of the Australian health policy landscape. Social and cultural determinants of health are patient-important factors for many families and communities accessing health support for dialysis-requiring kidney failure in the Northern Territory (NT). The NT has a dispersed population of 228 822 people, of whom nearly 27% identify as Aboriginal and/or Torres Strait Islander, with a majority who live in very remote NT communities. An estimated 85% of dialysis-dependent Territorians identify as Aboriginal and/or Torres Strait Islander, and relocating to access dialysis treatment is a disparate health outcome not usually experienced by non-Indigenous Territorians. As well as physical dislocation, this has included social, cultural and emotional hardship. In combination, slowing progression of kidney disease, sustaining residual kidney function that permits health and results in a safe delay of dialysis initiation, and promoting access to self-care dialysis and transplantation are profoundly important health outcomes. Reporting the attainment of patient-preferred outcomes not only validates care processes but also asserts health sovereignty for Aboriginal and Torres Strait Islander people. When these care principles are adopted as standard practice, there is an optimistic expectation of reducing health disparities.