Abstract
BackgroundThe international evidence about outcomes of End Stage Kidney Disease (ESKD) for ethnic minorities was reviewed to identify gaps and make recommendations for researchers and policy makers.MethodsNine databases were searched systematically with 112 studies from 14 different countries included and analysed to produce a thematic map of the literature.ResultsReviews (n = 26) highlighted different mortality rates and specific causes between ethnic groups and by stage of kidney disease associated with individual, genetic, social and environmental factors. Primary studies focussing on uptake of treatment modalities (n = 19) found ethnic differences in access. Research evaluating intermediate outcomes and quality of care in different treatment phases (n = 35) e.g. dialysis adequacy, transplant evaluation and immunosuppression showed ethnic minorities were disadvantaged. This is despite a survival paradox for some ethnic minorities on dialysis seen in studies of longer term outcomes (n = 29) e.g. in survival time post-transplant and mortality. There were few studies which focussed on end of life care (n = 3) and ethnicity.Gaps identified were: limited evidence from all stages of the ESKD pathway, particularly end of life care; a lack of system oriented studies with a reliance on national routine datasets which are limited in scope; a dearth of qualitative studies; and a lack studies from many countries with limited cross country comparison and learning.ConclusionsDifferences between ethnic groups occur at various points and in a variety of outcomes throughout the kidney care system. The combination of individual factors and system related variables affect ethnic groups differently indicating a need for culturally intelligent policy informed by research to prevent disadvantage.
Highlights
The international evidence about outcomes of End Stage Kidney Disease (ESKD) for ethnic minorities was reviewed to identify gaps and make recommendations for researchers and policy makers
This review was the first step in a systematic approach to learn as much as possible from the evidence about inequalities in outcomes for people living and dying with ESKD who are from ethnic minority groups
These focussed on ESKD and included analysis of outcomes for ethnic minorities in 14 different countries listed in Fig. 2 which shows a breakdown of the included papers by author country of origin and / or country focus
Summary
The international evidence about outcomes of End Stage Kidney Disease (ESKD) for ethnic minorities was reviewed to identify gaps and make recommendations for researchers and policy makers. This review was the first step in a systematic approach to learn as much as possible from the evidence about inequalities in outcomes for people living and dying with ESKD who are from ethnic minority groups. This review took a broad perspective and incorporated the international literature. The objectives of this international systematic scoping review were to: identify the evidence base of inequalities in the outcomes of end stage kidney disease for ethnic minorities; map the international literature; identify gaps and make recommendations for research and policy towards reducing and Wilkinson et al BMC Nephrology (2019) 20:234 preventing inequalities in kidney care in the UK and globally
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