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

David J Tunnicliffe; Samantha Bateman; Melissa Arnold-Chamney; Karen M Dwyer; Martin Howell; Azaria Gebadi; Shilpa Jesudason; Janet Kelly; Kelly Lambert; Sandawan William Majoni; Dora Oliva; Kelli J Owen; Odette Pearson; Elizabeth Rix; Ieyesha Roberts; Kimberly Taylor; Gary A Wittert; Katherine Widders; Adela Yip; Jonathan Craig; Richard K Phoon

doi:10.5694/mja2.52114

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

Journal article

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

David J Tunnicliffe, Samantha Bateman, Melissa Arnold-Chamney, Karen M Dwyer, Martin Howell, Azaria Gebadi, Shilpa Jesudason, Janet Kelly, Kelly Lambert, Sandawan William Majoni, …

Medical journal of Australia, Vol.219(8), pp.374-385

10/2023

DOI: https://doi.org/10.5694/mja2.52114

Appears in Recent Gnibi College of Indigenous Australian Peoples Publications

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Abstract

Guidelines as topic

Kidney diseases

Renal dialysis

Health services

Social determinants of health

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.

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Title: Recommendations for culturally safe clinical kidney care for First Nations Australians: a guideline summary
Creators: David J Tunnicliffe - University of Sydney
Samantha Bateman - University of Adelaide
Melissa Arnold-Chamney - University of Adelaide Adelaide SA
Karen M Dwyer - Deakin University
Martin Howell - University of Sydney
Azaria Gebadi - University of Sydney
Shilpa Jesudason - Kidney Health Australia (Adelaide, SA)
Janet Kelly - University of Adelaide
Kelly Lambert - University of Wollongong
Sandawan William Majoni - Royal Darwin Hospital
Dora Oliva - Drug and Alcohol Services, South Australia Health Adelaide SA
Kelli J Owen - University of Adelaide
Odette Pearson - South Australian Health and Medical Research Institute
Elizabeth Rix - Southern Cross University
Ieyesha Roberts - University of Sydney
Kimberly Taylor - South Australian Health and Medical Research Institute
Gary A Wittert - University of Adelaide
Katherine Widders - University of Sydney
Adela Yip - University of Sydney
Jonathan Craig - Flinders University
Richard K Phoon - University of Sydney
Publication Details: Medical journal of Australia, Vol.219(8), pp.374-385
Publisher: Wiley
Grant note: Australian Government Department of Health and Aged Care National Health and Medical Research Council. Grant Number: Emerging Leadership 1 Investigator Grant APP119733
Identifiers: 991013143472902368
Copyright: © 2023 The Authors. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd. This is an open access article under the terms of the Creative Commons Attribution License.
Academic Unit: Gnibi College of Indigenous Australian Peoples
Language: English
Resource Type: Journal article

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

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