Recommendations for culturally safe clinical kidney care for First Nations Australians: a guideline summary.
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Date
2024-04-24
Journal Title
Journal ISSN
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Affiliation(s)
(Tunnicliffe, Howell, Gebadi, Roberts, Widders, Yip, Phoon) University of Sydney, Sydney, NSW, Australia
(Tunnicliffe, Howell, Gebadi, Roberts, Widders, Yip) Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
(Bateman, Arnold-Chamney, Kelly, Owen, Rix, Wittert) University of Adelaide, Adelaide, SA, Australia
(Bateman) Central and Northern Adelaide Renal and Transplantation Services, Central Adelaide Local Health Network, Adelaide, SA, Australia
(Dwyer) Deakin University, Geelong, VIC, Australia
(Jesudason) Kidney Health Australia, Adelaide, SA, Australia
(Lambert) University of Wollongong, Wollongong, NSW, Australia
(Lambert) Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
(Majoni) Royal Darwin Hospital, Darwin, NT, Australia
(Majoni, Craig) Flinders University, Adelaide, SA, Australia
(Oliva) Drug and Alcohol Services, South Australia Health, Adelaide, SA, Australia
(Owen) Central and Northern Adelaide Renal and Transplantation, Royal Adelaide Hospital, Adelaide, SA, Australia
(Pearson) Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
(Pearson) Cancer Research Institute, University of South Australia, Adelaide, SA, Australia
(Rix) Southern Cross University, Lismore, NSW, Australia
(Taylor) Aboriginal Communities and Families Health Research Alliance, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
(Wittert) Royal Adelaide Hospital, Adelaide, SA, Australia
(Phoon) Westmead Hospital, Sydney, NSW, Australia
(Tunnicliffe, Howell, Gebadi, Roberts, Widders, Yip) Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
(Bateman, Arnold-Chamney, Kelly, Owen, Rix, Wittert) University of Adelaide, Adelaide, SA, Australia
(Bateman) Central and Northern Adelaide Renal and Transplantation Services, Central Adelaide Local Health Network, Adelaide, SA, Australia
(Dwyer) Deakin University, Geelong, VIC, Australia
(Jesudason) Kidney Health Australia, Adelaide, SA, Australia
(Lambert) University of Wollongong, Wollongong, NSW, Australia
(Lambert) Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
(Majoni) Royal Darwin Hospital, Darwin, NT, Australia
(Majoni, Craig) Flinders University, Adelaide, SA, Australia
(Oliva) Drug and Alcohol Services, South Australia Health, Adelaide, SA, Australia
(Owen) Central and Northern Adelaide Renal and Transplantation, Royal Adelaide Hospital, Adelaide, SA, Australia
(Pearson) Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
(Pearson) Cancer Research Institute, University of South Australia, Adelaide, SA, Australia
(Rix) Southern Cross University, Lismore, NSW, Australia
(Taylor) Aboriginal Communities and Families Health Research Alliance, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
(Wittert) Royal Adelaide Hospital, Adelaide, SA, Australia
(Phoon) Westmead Hospital, Sydney, NSW, Australia
Year
2023
Citation
Medical Journal of Australia. Vol.219(8), 2023, pp. 374-385.
Journal
Medical Journal of Australia
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Grant information
Organisation: (DHAC) Department of Health and Aged Care, Australian Government Organisation No: 501100003921 Country: Australia
No: Emerging Leadership 1 Investigator Grant APP119733 Organisation: (NHMRC) National Health and Medical Research Council Organisation No: 501100000925 Country: Australia
No: Emerging Leadership 1 Investigator Grant APP119733 Organisation: (NHMRC) National Health and Medical Research Council Organisation No: 501100000925 Country: Australia
Abstract
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.Copyright © 2023 The Authors. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.
PubMed ID
37838977 [https://www.ncbi.nlm.nih.gov/pubmed/?term=37838977]
Type
Article
Study type
Subjects
Cultural safety