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
Author Information
David J Tunnicliffe: University of Sydney, Sydney, NSW. ORCID
Samantha Bateman: University of Adelaide, Adelaide, SA. ORCID
Melissa Arnold-Chamney: University of Adelaide, Adelaide, SA.
Karen M Dwyer: Deakin University, Geelong, VIC. ORCID
Martin Howell: University of Sydney, Sydney, NSW.
Azaria Gebadi: University of Sydney, Sydney, NSW.
Shilpa Jesudason: Kidney Health Australia, Adelaide, SA.
Janet Kelly: University of Adelaide, Adelaide, SA.
Kelly Lambert: University of Wollongong, Wollongong, NSW.
Sandawan William Majoni: Royal Darwin Hospital, Darwin, NT.
Dora Oliva: Drug and Alcohol Services, South Australia Health, Adelaide, SA.
Kelli J Owen: University of Adelaide, Adelaide, SA.
Odette Pearson: Wardliparingga Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, SA.
Elizabeth Rix: University of Adelaide, Adelaide, SA.
Ieyesha Roberts: University of Sydney, Sydney, NSW.
Kimberly Taylor: Aboriginal Communities and Families Health Research Alliance, South Australian Health and Medical Research Institute, Adelaide, SA.
Gary A Wittert: University of Adelaide, Adelaide, SA.
Katherine Widders: University of Sydney, Sydney, NSW.
Adela Yip: University of Sydney, Sydney, NSW.
Jonathan Craig: Flinders University, Adelaide, SA.
Richard K Phoon: University of Sydney, Sydney, NSW.
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 m , and a sustained decrease in eGFR, > 10 mL/min/1.73 m 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.
