Recommendations for culturally safe clinical kidney care for First Nations Australians: a guideline summary

Authors

David J. Tunnicliffe, The University of Sydney
Samantha Bateman, The University of Adelaide
Melissa Arnold-Chamney, The University of Adelaide
Karen M. Dwyer, Deakin University
Martin Howell, The University of Sydney
Azaria Gebadi, The University of Sydney
Shilpa Jesudason, Kidney Health Australia
Janet Kelly, The University of Adelaide
Kelly Lambert, University of Wollongong
Sandawan William Majoni, Royal Darwin Hospital
Dora Oliva, Drug & Alcohol Services South Australia
Kelli J. Owen, The University of Adelaide
Odette Pearson, South Australian Health and Medical Research Institute
Elizabeth Rix, The University of Adelaide
Ieyesha Roberts, The University of Sydney
Kimberly Taylor, South Australian Health and Medical Research Institute
Gary A. Wittert, The University of Adelaide
Katherine Widders, The University of Sydney
Adela Yip, The University of Sydney
Jonathan Craig, Flinders University
Richard K. Phoon, The University of Sydney

Publication Name

Medical Journal of 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.

Open Access Status

This publication may be available as open access

Volume

219

Issue

8

First Page

374

Last Page

385

Funding Number

APP1197337

Funding Sponsor

Bayer