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Objectives: To assess differences between Aboriginal and Torres Strait Islander and non‐Indigenous Australian children and young adults in access to and outcomes of kidney transplantation. Study design: A cohort study based on prospectively collected data; analysis of Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data. Setting, participants: Children and young adults aged 0–24 years who commenced kidney replacement therapy in Australia during 1963–2020. Main outcome measures: Proportions of children and young adults who received kidney transplants within five years of commencing dialysis; 5‐ and 10‐year death‐censored graft survival; and 5‐ and 10‐year survival of children and young adults who received kidney transplants or who remained on dialysis. Results: During 1963–2020, 3736 children and young adults received kidney replacement therapy in Australia: 213 (5.8%) Aboriginal and Torres Strait Islander and 3523 (94.2%) non‐Indigenous children and young adults. During follow‐up (median, eight years; interquartile range [IQR], 2.6–15 years), 2762 children and young adults received kidney transplants: 93 Aboriginal and Torres Strait Islander (43.7% of those receiving kidney replacement therapy) and 2669 non‐Indigenous children and young adults (75.8%). Smaller proportions of Aboriginal and Torres Strait Islander than of non‐Indigenous children and young adults received transplants within five years of commencing dialysis (99, 46% v 2924, 83.0%), received living donor transplants (19, 20% v 1170, 43.9%), or underwent pre‐emptive transplantation (one, 1.1% v 363, 13.6%). Five‐year graft survival for Aboriginal and Torres Strait Islander recipients was similar to non‐Indigenous recipients (61% v 75%; adjusted hazard ratio [aHR], 1.43; 95% confidence interval [CI], 0.02–2.05), but 10‐year graft survival was lower (35% v 61%; aHR, 1.69; 95% CI, 1.25–2.28). Five‐ and 10‐year survival after kidney transplantation was similar for Aboriginal and Torres Strait Islander and non‐Indigenous people. Among those who remained on dialysis, 10‐year survival was poorer for Aboriginal and Torres Strait Islander than non‐Indigenous children and young adults (aHR, 1.50; 95% CI, 1.08–2.10). Conclusions: Five‐year graft and recipient survival were excellent for Aboriginal and Torres Strait Islander children and young adults who received kidney transplants; however, a lower proportion received transplants within five years of dialysis initiation, than non‐Indigenous children and young adults. Improving transplant access within five years of dialysis commencement should be a priority. [ABSTRACT FROM AUTHOR]

This article explores the significance of providing optimal care for Aboriginal and Torres Strait Islander peoples with kidney failure in the Northern Territory of Australia. It emphasizes the importance of addressing health disparities and cultural factors that influence health outcomes in order to improve the well-being of these communities. The article presents a case study of a Torres Strait Islander woman's health journey, highlighting the integration of traditional healing practices with biomedical approaches and the value of patient-centered care. Additionally, the article discusses the role of Storying, a method of knowledge collation and archiving in Aboriginal and Torres Strait Islander cultures, in amplifying marginalized voices and serving as an educational tool for healthcare providers and Indigenous individuals. The article underscores the significance of culturally sensitive care and patient autonomy in achieving positive health outcomes for Indigenous communities, and advocates for a model of care that prioritizes Indigenous self-determination, cultural safety, and acknowledges the social and cultural determinants of health. It also emphasizes the need for sustained support for Indigenous self-determination and the development of a diverse healthcare workforce to comprehensively address Indigenous health needs. [Extracted from the article]

The incidence of chronic kidney disease (CKD) is increasing worldwide. A holistic approach to management that includes nonpharmacological and pharmacological strategies to manage risk factors, as well as advocating for patients, particularly those most at risk, can significantly slow the progression of CKD. Input from multidisciplinary team members, including a nephrologist, CKD nurse and allied health professionals, can further reduce the progression of CKD, delay kidney failure and avoid CKD-related mortality. [ABSTRACT FROM AUTHOR]

The Zenadh Health Science Research and Education Council is being established as a physical infrastructure to unite Zenadh (Torres Strait) culture with Eurocentric sciences. The Council aims to secure and maximize Zenadh knowledge and skills while incorporating Eurocentric scientific practices. It is a means for Torres Strait Islander peoples to exercise their right to free, prior, and informed consent in scientific inquiry and to promote their political autonomy and self-determination. The Council will work on various health initiatives, such as providing haemodialysis services and reducing complications of diabetes. The authors emphasize the importance of cultural protocols and language in their work and express their desire for culturally honoring supporters and enablers of their survival. [Extracted from the article]

Abstract Background There is an overwhelming burden of cardiovascular disease, type 2 diabetes and chronic kidney disease among Indigenous Australians. In this high risk population, it is vital that we are able to measure accurately kidney function. Glomerular filtration rate is the best overall marker of kidney function. However, differences in body build and body composition between Indigenous and non-Indigenous Australians suggest that creatinine-based estimates of glomerular filtration rate derived for European populations may not be appropriate for Indigenous Australians. The burden of kidney disease is borne disproportionately by Indigenous Australians in central and northern Australia, and there is significant heterogeneity in body build and composition within and amongst these groups. This heterogeneity might differentially affect the accuracy of estimation of glomerular filtration rate between different Indigenous groups. By assessing kidney function in Indigenous Australians from Northern Queensland, Northern Territory and Western Australia, we aim to determine a validated and practical measure of glomerular filtration rate suitable for use in all Indigenous Australians. Methods/Design A cross-sectional study of Indigenous Australian adults (target n = 600, 50% male) across 4 sites: Top End, Northern Territory; Central Australia; Far North Queensland and Western Australia. The reference measure of glomerular filtration rate was the plasma disappearance rate of iohexol over 4 hours. We will compare the accuracy of the following glomerular filtration rate measures with the reference measure: Modification of Diet in Renal Disease 4-variable formula, Chronic Kidney Disease Epidemiology Collaboration equation, Cockcroft-Gault formula and cystatin C- derived estimates. Detailed assessment of body build and composition was performed using anthropometric measurements, skinfold thicknesses, bioelectrical impedance and a sub-study used dual-energy X-ray absorptiometry. A questionnaire was performed for socio-economic status and medical history. Discussion We have successfully managed several operational challenges within this multi-centre complex clinical research project performed across remote North, Western and Central Australia. It seems unlikely that a single correction factor (similar to that for African-Americans) to the equation for estimated glomerular filtration rate will prove appropriate or practical for Indigenous Australians. However, it may be that a modification of the equation in Indigenous Australians would be to include a measure of fat-free mass.

Published evidence confirms poor access to wait-listing for kidney transplantation for Aboriginal and Torres Strait Islander Australians from the Northern Territory. This study aimed to identify the practical causes and recommend improvement. Pathways to wait-listing for a kidney transplant were reviewed to identify potential barriers. Processes were mapped to identify potential problem areas, provide comparison of the actual versus the ideal, identify where data needed collecting and provide clear presentation of the processes. Staff involved in the work-up of patients going for wait-listing were asked to list the barriers. Data were collected for patients from the transplant database between 1 January 2017 to 31 August 2018. Quality improvement statistical processes and charts were used to analyse and present the results. There were 102 patients in the transplant work-up process; 81.4% were Aboriginal and Torres Strait Islander, 71.6% were progressing with the work-up, 28.4% were on-hold. Of the 29 patients on hold, 92.9% were Aboriginal and Torres Strait Islander. Causes of delays to wait-listing included: failure to attend appointments due to competing priorities and communication barriers, access and navigating complex pathways to specialist services, transport, co-morbidities requiring multiple tests and multiple specialty services, and pressures on dialysis and hospital bed capacity. In conclusion, barriers to wait-listing for kidney transplantation for Aboriginal and Torres Strait Islander Australians are complex and can be addressed by redesigning healthcare provision, including increasing the Aboriginal and Torres Strait Islander workforce to provide education and patient navigation of the healthcare system and improve communication, streamlining investigations and coordinating specialist services. What is known about the topic?: Access to wait-listing for kidney transplantation for Aboriginal and Torres Strait Islander Australians from the Northern Territory is poor. Barriers to wait-listing for kidney transplantation can occur anywhere along the pathway of care from a patient's first contact with the renal service to wait-listing. What does this paper add?: Identified barriers to wait-listing for kidney transplantation include health service workforce and resources shortages, patient and health service barriers such as patients' competing priorities, poor communication between the health service and patients, transport and accommodation for patients from remote communities, complex comorbidities, and access to specialist services. What are the implications for practitioners?: Recruitment and retention of Aboriginal and Torres Strait Islander mentors, healthcare workers and patient navigators should be prioritised to provide an effective culturally appropriate service. Effective communication strategies with patients and improved access to streamlined appropriate investigations and collaboration among specialist services will invariably improve access to wait-listing for kidney transplantation. [ABSTRACT FROM AUTHOR]

Objective: This cross-sectional study investigated the relationship between individual-level markers of disadvantage, renal function and cardio-metabolic risk within an Indigenous population characterised by a heavy burden of chronic kidney disease and disadvantage. Design: Using data from 20 Indigenous communities across Australia, an aggregate socio-economic status (SES) score was created from individual-level socio-economic variables reported by participants. Logistic regression was used to assess the association of individual-level socio-economic variables and the SES score with kidney function (an estimated glomerular function rate (eGFR) cut-point of <60 ml/min/1.73 m2) as well as clinical indicators of cardio-metabolic risk. Results: The combination of lower education and unemployment was associated with poorer kidney function and higher cardio-metabolic risk factors. Regression models adjusted for age and gender showed that an eGFR < 60 ml/min/1.73 m2 was associated with a low socio-economic score (lowest vs. highest 3.24 [95% CI 1.43–6.97]), remote living (remote vs. highly to moderately accessible 3.24 [95% CI 1.28–8.23]), renting (renting vs. owning/being purchased 5.76[95% CI 1.91–17.33]), unemployment (unemployed vs employed 2.85 [95% CI 1.31–6.19]) and receiving welfare (welfare vs. salary 2.49 [95% CI 1.42–4.37]). A higher aggregate socio-economic score was inversely associated with an eGFR < 60 ml/min/1.73 m2 (0.75 [95% CI 063–0.89]). Conclusion: This study extends upon our understanding of associations between area-level markers of disadvantage and burden of end stage kidney disease amongst Indigenous populations to a detailed analysis of a range of well-characterised individual-level factors such as overall low socio-economic status, remote living, renting, unemployment and welfare. With the increasing burden of end-stage kidney disease amongst Indigenous people, the underlying socio-economic conditions and social and cultural determinants of health need to be understood at an individual as well as community-level, to develop, implement, target and sustain interventions. [ABSTRACT FROM AUTHOR]