TY - JOUR
T1 - Recommendations for culturally safe clinical kidney care for First Nations Australians
T2 - a guideline summary
AU - Tunnicliffe, David J.
AU - Bateman, Samantha
AU - Arnold-Chamney, Melissa
AU - Dwyer, Karen M.
AU - Howell, Martin
AU - Gebadi, Azaria
AU - Jesudason, Shilpa
AU - Kelly, Janet
AU - Lambert, Kelly
AU - Majoni, Sandawan William
AU - Oliva, Dora
AU - Owen, Kelli J.
AU - Pearson, Odette
AU - Rix, Elizabeth
AU - Roberts, Ieyesha
AU - Taylor, Kimberly
AU - Wittert, Gary A.
AU - Widders, Katherine
AU - Yip, Adela
AU - Craig, Jonathan
AU - Phoon, Richard K.
PY - 2023/10
Y1 - 2023/10
N2 - Introduction: First Nations Australians display remarkable strength and resilience despite the intergenerational impacts of ongoing colonisation. The continuing disadvantage is evident in the higher incidence, prevalence, morbidity and mortality of chronic kidney disease (CKD) among First Nations Australians. Nationwide community consultation (Kidney Health Australia, Yarning Kidneys, and Lowitja Institute, Catching Some Air) identified priority issues for guideline development. These guidelines uniquely prioritised the knowledge of the community, alongside relevant evidence using an adapted GRADE Evidence to Decision framework to develop specific recommendations for the management of CKD among First Nations Australians. Main recommendations: These guidelines explicitly state that health systems have to measure, monitor and evaluate institutional racism and link it to cultural safety training, as well as increase community and family involvement in clinical care and equitable transport and accommodation. The guidelines recommend earlier CKD screening criteria (age ≥ 18 years) and referral to specialists services with earlier criteria of kidney function (eg, estimated glomerular filtration rate [eGFR], ≤ 45 mL/min/1.73 m2, and a sustained decrease in eGFR, > 10 mL/min/1.73 m2 per year) compared with the general population. Changes in management as result of the guidelines: Our recommendations prioritise health care service delivery changes to address institutional racism and ensure meaningful cultural safety training. Earlier detection of CKD and referral to nephrologists for First Nations Australians has been recommended to ensure timely implementation to preserve kidney function given the excess burden of disease. Finally, the importance of community with the recognition of involvement in all aspects and stages of treatment together with increased access to care on Country, particularly in rural and remote locations, including dialysis services.
AB - Introduction: First Nations Australians display remarkable strength and resilience despite the intergenerational impacts of ongoing colonisation. The continuing disadvantage is evident in the higher incidence, prevalence, morbidity and mortality of chronic kidney disease (CKD) among First Nations Australians. Nationwide community consultation (Kidney Health Australia, Yarning Kidneys, and Lowitja Institute, Catching Some Air) identified priority issues for guideline development. These guidelines uniquely prioritised the knowledge of the community, alongside relevant evidence using an adapted GRADE Evidence to Decision framework to develop specific recommendations for the management of CKD among First Nations Australians. Main recommendations: These guidelines explicitly state that health systems have to measure, monitor and evaluate institutional racism and link it to cultural safety training, as well as increase community and family involvement in clinical care and equitable transport and accommodation. The guidelines recommend earlier CKD screening criteria (age ≥ 18 years) and referral to specialists services with earlier criteria of kidney function (eg, estimated glomerular filtration rate [eGFR], ≤ 45 mL/min/1.73 m2, and a sustained decrease in eGFR, > 10 mL/min/1.73 m2 per year) compared with the general population. Changes in management as result of the guidelines: Our recommendations prioritise health care service delivery changes to address institutional racism and ensure meaningful cultural safety training. Earlier detection of CKD and referral to nephrologists for First Nations Australians has been recommended to ensure timely implementation to preserve kidney function given the excess burden of disease. Finally, the importance of community with the recognition of involvement in all aspects and stages of treatment together with increased access to care on Country, particularly in rural and remote locations, including dialysis services.
KW - Guidelines as topic
KW - Health services
KW - Kidney diseases
KW - Renal dialysis
KW - Social determinants of health
UR - http://www.scopus.com/inward/record.url?scp=85174456039&partnerID=8YFLogxK
U2 - 10.5694/mja2.52114
DO - 10.5694/mja2.52114
M3 - Article
C2 - 37838977
AN - SCOPUS:85174456039
SN - 0025-729X
VL - 219
SP - 374
EP - 385
JO - Medical Journal of Australia
JF - Medical Journal of Australia
IS - 8
ER -
