Abstract
BackgroundIn common with Indigenous populations elsewhere, Indigenous Australians have higher incidence of end-stage kidney disease (ESKD), but lower transplantation rates than their non-Indigenous counterparts. Understanding how the demands of dialysis impact on, and are impacted by, the lives of Indigenous patients may provide important insight into treatment pathways and decision-making.MethodsWe conducted semi-structured interviews in 2005–06 with 146 Indigenous and 95 non-Indigenous patients from nine hospital renal wards and 17 associated dialysis centres, which together treat the majority of Indigenous Australian ESKD patients.ResultsFactors influencing treatment experience included: the impacts of late diagnosis; family separations associated with relocating for treatment; the physical and psychosocial demands of hemodialysis; and ineffective communication between health care providers and patients. Although not unique to them, Indigenous patients were more likely to experience the combined effect of all factors.ConclusionsSocial/situational circumstances profoundly affect Indigenous Australian dialysis patients’ ability to fully engage with treatment. This may ultimately affect their likelihood of receiving optimal treatment, including transplantation. Areas for improvement include: earlier diagnosis; improved linkages between specialist renal services and primary care in regional settings; more effective communication and patient education; and more systematic, transparent approaches to patient “compliance” in transplant and home dialysis guidelines.
Highlights
In common with Indigenous populations elsewhere, Indigenous Australians have higher incidence of end-stage kidney disease (ESKD), but lower transplantation rates than their non-Indigenous counterparts
This paper presents the views and experiences of Indigenous Australian ESKD patients undergoing dialysis, comparing them with those of non-Indigenous patients
Data presented here were collected as part of IMPAKT (Improving Access to Kidney Transplants), an integrated, mixed-methods program of work investigating barriers faced by Indigenous ESKD patients in accessing kidney transplants
Summary
In common with Indigenous populations elsewhere, Indigenous Australians have higher incidence of end-stage kidney disease (ESKD), but lower transplantation rates than their non-Indigenous counterparts. In common with Indigenous populations in the US, Canada and New Zealand, Indigenous Australians have higher incidence of end-stage kidney disease (ESKD), but lower transplantation rates than their nonIndigenous counterparts [1,2,3,4]. In 2005, 45.4% of non-Indigenous treated ESKD patients in Australia had a functioning transplant, compared with only 12.7% of treated Indigenous patients; corresponding figures for 2009 were 45.9% and 12.0% [1]. Reasons for these disparities are not completely understood, but clinical factors alone do not explain them. Much of a dialysis patient’s life is spent travelling to/from dialysis sessions, having treatment, and recovering afterwards
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