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Chen W, Howard K, Gorham G, Abeyaratne A, Zhao Y, Adegboye O, Kangaharan N, Talukder MRR, Taylor S, Cass A. Costs and healthcare use of patients with chronic kidney disease in the Northern Territory, Australia. BMC Health Serv Res 2024; 24:791. [PMID: 38982437 DOI: 10.1186/s12913-024-11258-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 06/27/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND The burden of chronic kidney disease (CKD) is high in the Northern Territory (NT), Australia. This study aims to describe the healthcare use and associated costs of people at risk of CKD (e.g. acute kidney injury, diabetes, hypertension, and cardiovascular disease) or living with CKD in the NT, from a healthcare funder perspective. METHODS We included a retrospective cohort of patients at risk of, or living with CKD, on 1 January 2017. Patients on kidney replacement therapy were excluded from the study. Data from the Territory Kidney Care database, encompassing patients from public hospitals and primary health care services across the NT was used to conduct costing. Annual healthcare costs, including hospital, primary health care, medication, and investigation costs were described over a one-year follow-up period. Factors associated with high total annual healthcare costs were identified with a cost prediction model. RESULTS Among 37,398 patients included in this study, 23,419 had a risk factor for CKD while 13,979 had CKD (stages 1 to 5, not on kidney replacement therapy). The overall mean (± SD) age was 45 years (± 17), and a large proportion of the study cohort were First Nations people (68%). Common comorbidities in the overall cohort included diabetes (36%), hypertension (32%), and coronary artery disease (11%). Annual healthcare cost was lowest in those at risk of CKD (AUD$7,958 per person) and highest in those with CKD stage 5 (AUD$67,117 per person). Inpatient care contributed to the majority (76%) of all healthcare costs. Predictors of increased total annual healthcare cost included more advanced stages of CKD, and the presence of comorbidities. In CKD stage 5, the additional cost per person per year was + $53,634 (95%CI 32,769 to 89,482, p < 0.001) compared to people in the at risk group without CKD. CONCLUSION The total healthcare costs in advanced stages of CKD is high, even when patients are not on dialysis. There remains a need for effective primary prevention and early intervention strategies targeting CKD and related chronic conditions.
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Affiliation(s)
- Winnie Chen
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, Australia.
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Kirsten Howard
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Gillian Gorham
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, Australia
| | - Asanga Abeyaratne
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, Australia
- NT Health, Darwin, Australia
| | | | - Oyelola Adegboye
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, Australia
| | | | | | - Sean Taylor
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, Australia
- NT Health, Darwin, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, Australia
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Ferguson B, Doan V, Shoker A, Abdelrasoul A. A comprehensive exploration of chronic kidney disease and dialysis in Canada's Indigenous population: from epidemiology to genetic influences. Int Urol Nephrol 2024:10.1007/s11255-024-04122-5. [PMID: 38898356 DOI: 10.1007/s11255-024-04122-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 06/13/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE This study aims to review the escalating prevalence of chronic kidney disease (CKD) and end-stage renal disease (ESRD) among Canada's Indigenous population, focusing on risk factors, hospitalization and mortality rates, and disparities in kidney transplantation. The study explores how these factors contribute to the health outcomes of this population and examines the influence of genetic variations on CKD progression. METHODS The review synthesizes data on prevalence rates, hospitalization and mortality statistics, and transplantation disparities among Indigenous individuals. It also delves into the complexities of healthcare access, including geographical, socioeconomic, and psychological barriers. Additionally, the manuscript investigates the impact of racial factors on blood characteristics relevant to dialysis treatment and the genetic predispositions influencing disease progression in Indigenous populations. RESULTS Indigenous individuals exhibit a higher prevalence of CKD and ESRD risk factors such as diabetes and obesity, particularly in regions like Saskatchewan. These patients face a 77% higher risk of death compared to their non-Indigenous counterparts and are less likely to receive kidney transplants. Genetic analyses reveal significant associations between CKD and specific genomic variations. Through analyses, we found that healthy Indigenous individuals may have higher levels of circulating inflammatory markers, which could become further elevated for those with CKD. In particular, they may have higher levels of C-reactive protein (CRP) fibrinogen, as well as genomic variations that affect IL-6 production and the function of von Willebrand Factor (vWF) which has critical potential influence on the compatibility with dialysis membranes contributing to complications in dialysis. CONCLUSION Indigenous people in Canada are disproportionately burdened by CKD and ESRD due to socioeconomic factors and potential genetic predispositions. While significant efforts have been made to assess the socioeconomic conditions of the Indigenous population, the genetic factors and their potential critical influence on compatibility with dialysis membranes, contributing to treatment complications, remain understudied. Further investigation into these genetic predispositions is essential.
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Affiliation(s)
- Braiden Ferguson
- Division of Biomedical Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK, S7N 5A9, Canada
| | - Victoria Doan
- Division of Biomedical Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK, S7N 5A9, Canada
| | - Ahmed Shoker
- Saskatchewan Transplant Program, St. Paul's Hospital, 1702 20Th Street West, Saskatoon, SK, S7M 0Z9, Canada
- Nephrology Division, College of Medicine, University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK, S7N 5E5, Canada
| | - Amira Abdelrasoul
- Division of Biomedical Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK, S7N 5A9, Canada.
- Department of Chemical and Biological Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK, S7N 5A9, Canada.
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Chu G, Silva C, Adams K, Chacko B, Attia J, Nathan N, Wilson R. Exploring the factors affecting home dialysis patients' participation in telehealth-assisted home visits: A mixed-methods study. J Ren Care 2024; 50:128-137. [PMID: 37434485 DOI: 10.1111/jorc.12475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Technology, such as telehealth, is increasingly used to support home dialysis patients. The challenges patients and carers face when home dialysis nursing visits are provided via telehealth have yet to be explored. OBJECTIVES To explore patients' and carers' perspectives as they transition to telehealth-assisted home visits and identify the factors influencing their engagement in this modality. DESIGN A mixed-methods approach, guideed by the behaviour change wheel using the capability, opportunity, motivation-behaviour model to explore individual's perceptions of telehealth. PARTCIPANTS Home dialysis patients and their carers. MEASURUEMENTS Suveys and qualitative interviews. METHODS A mixed-methods approach was undertaken, combining surveys and qualitative interviews. It was guided by the Behaviour Change Wheel using the Capability, Opportunity, Motivation- Behaviour model to explore individuals' perceptions of telehealth. RESULTS Thirty-four surveys and 21 interviews were completed. Of 34 survey participants, 24 (70%) preferred face-to-face home visits and 23 (68%) had previously engaged in telehealth. The main perceived barrier identified in the surveys was knowledge of telehealth, but participants believed there were opportunities for them to use telehealth. Interview results revealed that the convenience and flexibility of telehealth were perceived as the main advantages of telehealth. However, challenges such as the ability to conduct virtual assessments and to communicate effectively between clinicians and patients were identified. Patients from non-English speaking backgrounds and those with disabilities were particularly vulnerable because of the many barriers they faced. These challenges may further entrench the negative view regarding technology, as discussed by interview participants. CONCLUSION This study suggested that a blended model combining telehealth and face-to-face services would allow patient choice and is important to facilitate equity of care, particularly for those patients who were unwilling or had difficulty adopting technology.
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Affiliation(s)
- Ginger Chu
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Department of Nephrology, Medical & Interventional Services, John Hunter Hospital, Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | - Carla Silva
- Department of Nephrology, Medical & Interventional Services, John Hunter Hospital, Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | - Kelly Adams
- Department of Nephrology, Medical & Interventional Services, John Hunter Hospital, Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | - Bobby Chacko
- Department of Nephrology, Medical & Interventional Services, John Hunter Hospital, Hunter New England Local Health District, New Lambton, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - John Attia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Nicole Nathan
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
| | - Rhonda Wilson
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
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Cazzolli R, Sluiter A, Bateman S, Candler H, Cho Y, Cooper T, Craig JC, Dominello A, Duncanson E, Guha C, Hawley CM, Hewawasam E, Hickey L, Hill K, Howard K, Howell M, Huuskes BM, Irish GL, Jesudason S, Johnson DW, Kelly A, Leary D, Manera K, Mazis J, McDonald S, McLennan H, Muthuramalingam S, Pummeroy M, Scholes-Robertson N, Teixeira-Pinto A, Tunnicliffe DJ, van Zwieten A, Viecelli AK, Wong G, Jaure A. Improving Diverse and Equitable Involvement of Patients and Caregivers in Research in CKD: Report of a Better Evidence and Translation-Chronic Kidney Disease (BEAT-CKD) Workshop. Am J Kidney Dis 2024:S0272-6386(24)00784-4. [PMID: 38810688 DOI: 10.1053/j.ajkd.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/21/2024] [Accepted: 03/27/2024] [Indexed: 05/31/2024]
Abstract
Patient and caregiver involvement can enhance the uptake and impact of research, but the involvement of patients and caregivers who are underserved and marginalized is often limited. A better understanding of how to make involvement in research more broadly accessible, supportive, and inclusive for patients with chronic kidney disease (CKD) and caregivers is needed. We conducted a national workshop involving patients, caregivers, clinicians, and researchers from across Australia to identify strategies to increase the diversity of patients and caregivers involved in CKD research. Six themes were identified. Building trust and a sense of safety was considered pivotal to establishing meaningful relationships to support knowledge exchange. Establishing community and connectedness was expected to generate a sense of belonging to motivate involvement. Balancing stakeholder goals, expectations, and responsibilities involved demonstrating commitment and transparency by researchers. Providing adequate resources and support included strategies to minimize the burden of involvement for patients and caregivers. Making research accessible and relatable was about nurturing patient and caregiver interest by appealing to intrinsic motivators. Adapting to patient and caregiver needs and preferences required tailoring the approach for individuals and the target community. Strategies and actions to support these themes may support more diverse and equitable involvement of patients and caregivers in research in CKD.
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Affiliation(s)
- Rosanna Cazzolli
- Sydney School of Public Health, Faculty of Medicine and Health, Sydney; University of Sydney, and Centre for Kidney Research, Children's Hospital at Westmead, Sydney.
| | - Amanda Sluiter
- Sydney School of Public Health, Faculty of Medicine and Health, Sydney; University of Sydney, and Centre for Kidney Research, Children's Hospital at Westmead, Sydney
| | - Samantha Bateman
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide; Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide; Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health & Medical Research Institute, Adelaide
| | | | - Yeoungjee Cho
- Australasian Kidney Trials Network, Brisbane; Faculty of Medicine, Brisbane; University of Queensland, and Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane
| | - Tess Cooper
- Sydney School of Public Health, Faculty of Medicine and Health, Sydney; University of Sydney, and Centre for Kidney Research, Children's Hospital at Westmead, Sydney
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide
| | - Amanda Dominello
- Sydney School of Public Health, Faculty of Medicine and Health, Sydney; University of Sydney, and Centre for Kidney Research, Children's Hospital at Westmead, Sydney
| | - Emily Duncanson
- Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health & Medical Research Institute, Adelaide
| | - Chandana Guha
- Sydney School of Public Health, Faculty of Medicine and Health, Sydney; University of Sydney, and Centre for Kidney Research, Children's Hospital at Westmead, Sydney
| | - Carmel M Hawley
- Australasian Kidney Trials Network, Brisbane; Faculty of Medicine, Brisbane; University of Queensland, and Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane
| | - Erandi Hewawasam
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide; Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health & Medical Research Institute, Adelaide
| | | | - Kathy Hill
- Sydney School of Public Health, Faculty of Medicine and Health, Sydney
| | | | - Martin Howell
- Sydney School of Public Health, Faculty of Medicine and Health, Sydney; Menzies Centre for Health Policy and Economics, Sydney; University of Sydney, and Centre for Kidney Research, Children's Hospital at Westmead, Sydney
| | - Brooke M Huuskes
- Department of Microbiology, Anatomy, Physiology and Pharmacology, School of Agriculture. Biomedicine and Environment, La Trobe University, Melbourne
| | - Georgina L Irish
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide; Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide
| | - Shilpanjali Jesudason
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide; Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide
| | - David W Johnson
- Australasian Kidney Trials Network, Brisbane; Faculty of Medicine, Brisbane; University of Queensland, and Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane
| | - Ayano Kelly
- University of Sydney, and Centre for Kidney Research, Children's Hospital at Westmead, Sydney
| | - Diana Leary
- University of Queensland, and Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane
| | - Karine Manera
- Sydney School of Public Health, Faculty of Medicine and Health, Sydney; University of Sydney, and Centre for Kidney Research, Children's Hospital at Westmead, Sydney
| | - Jasmin Mazis
- Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health & Medical Research Institute, Adelaide
| | - Stephen McDonald
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide; Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide; Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health & Medical Research Institute, Adelaide
| | - Helen McLennan
- Sydney School of Public Health, Faculty of Medicine and Health, Sydney; University of Sydney, and Centre for Kidney Research, Children's Hospital at Westmead, Sydney
| | - Shyamsundar Muthuramalingam
- Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health & Medical Research Institute, Adelaide; Central Adelaide Local Health Network, Adelaide
| | | | - Nicole Scholes-Robertson
- University of Sydney, and Centre for Kidney Research, Children's Hospital at Westmead, Sydney; College of Medicine and Public Health, Flinders University, Adelaide
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, Faculty of Medicine and Health, Sydney; University of Sydney, and Centre for Kidney Research, Children's Hospital at Westmead, Sydney
| | - David J Tunnicliffe
- Sydney School of Public Health, Faculty of Medicine and Health, Sydney; University of Sydney, and Centre for Kidney Research, Children's Hospital at Westmead, Sydney
| | - Anita van Zwieten
- Sydney School of Public Health, Faculty of Medicine and Health, Sydney; University of Sydney, and Centre for Kidney Research, Children's Hospital at Westmead, Sydney
| | - Andrea K Viecelli
- Australasian Kidney Trials Network, Brisbane; Faculty of Medicine, Brisbane; University of Queensland, and Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane
| | - Germaine Wong
- Sydney School of Public Health, Faculty of Medicine and Health, Sydney; University of Sydney, and Centre for Kidney Research, Children's Hospital at Westmead, Sydney
| | - Allison Jaure
- Sydney School of Public Health, Faculty of Medicine and Health, Sydney; University of Sydney, and Centre for Kidney Research, Children's Hospital at Westmead, Sydney
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Gueguen L, Boyle B, Chune V, Dancer M, Leou S, Testevuide P, Delaval R, Faguer S. Epidemiology of End-Stage Kidney Disease in French Polynesia: A Plea for Standardized Diagnosis Workflow in Young Adults of First Nations People. Kidney Int Rep 2024; 9:1111-1114. [PMID: 38765559 PMCID: PMC11101812 DOI: 10.1016/j.ekir.2024.01.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/22/2023] [Accepted: 01/29/2024] [Indexed: 05/22/2024] Open
Affiliation(s)
- Lorraine Gueguen
- Service de Néphrologie, Hôpital du Taaone, Papeete, Tahiti, Polynésie Française
| | - Belinda Boyle
- Service d’Obstétrique, Hôpital du Taaone, Papeete, Tahiti, Polynésie Française
| | - Valérie Chune
- Laboratoire de Biologie, Hôpital du Taaone, Papeete, Tahiti, Polynésie Française
| | | | - Sylvie Leou
- Service de Néphrologie, Hôpital du Taaone, Papeete, Tahiti, Polynésie Française
| | - Pascale Testevuide
- Service de Néphrologie, Hôpital du Taaone, Papeete, Tahiti, Polynésie Française
| | - Ronan Delaval
- Service de Néphrologie, Hôpital du Taaone, Papeete, Tahiti, Polynésie Française
| | - Stanislas Faguer
- Département de Néphrologie et Transplantation d’organes, Centre de référence des maladies rénales rares, Toulouse, France
- Université Toulouse 3, Faculté de Médecine, Toulouse, France
- Institut National de la Santé et de la Recherche médicale, UMR 1297, Institut de Maladies Métaboliques et Cardiovasculaires, Toulouse, France
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Kerr M, Jaure A, Stephens JH, Kim S, Cutler R, Cashmore B, Dickson M, Evangelidis N, Hughes JT, Roberts I, Scholes-Robertson N, Sinka V, Craig JC. Experiences of Indigenous Patients Receiving Dialysis: Systematic Review of Qualitative Studies. Am J Kidney Dis 2024; 83:139-150.e1. [PMID: 37730171 DOI: 10.1053/j.ajkd.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/30/2023] [Accepted: 07/09/2023] [Indexed: 09/22/2023]
Abstract
RATIONALE & OBJECTIVE Indigenous People suffer a high burden of kidney disease. Those receiving maintenance dialysis have worse outcomes compared with similarly treated non-Indigenous patients. We characterized the experiences of Indigenous patients receiving dialysis in British-colonized countries to gain insights into which aspects of kidney care may benefit from improvement. STUDY DESIGN A systematic review of published qualitative interview studies. SETTING & STUDY POPULATIONS Indigenous Peoples aged 18 years and over, receiving hemodialysis or peritoneal dialysis in British-colonized countries. SELECTION CRITERIA FOR STUDIES Search terms for Indigenous Peoples, dialysis, and qualitative research were entered into Medline, Embase, PsycINFO, and CINAHL and searched from inception to January 5, 2023. DATA EXTRACTION Characteristics of each study were extracted into Microsoft Excel for quality assessment. ANALYTICAL APPROACH Data were analyzed using thematic synthesis. RESULTS The analysis included 28 studies involving 471 participants from Australia, New Zealand, Canada, and the United States. We identified four themes: centrality of family and culture (continuing dialysis for family, gaining autonomy through shared involvement, balancing primary responsibility to care for family); marginalization due to structural and social inequities (falling through gaps in primary care intensifying shock, discriminated against and judged by specialists, alienated and fearful of hospitals, overwhelmed by travel, financial and regimental burdens); vulnerability in accessing health care (need for culturally responsive care, lack of language interpreters, without agency in decision-making, comorbidities compounding complexity of self-management); and distress from separation from community (disenfranchisement and sorrow when away for dialysis, inability to perpetuate cultural continuity, seeking a kidney transplant). LIMITATIONS We only included articles published in English. CONCLUSIONS Indigenous patients receiving dialysis experience inequities in health care that compound existing accessibility issues caused by colonization. Improving the accessibility and cultural responsiveness of dialysis and kidney transplant services in collaboration with Indigenous stakeholders holds promise to enhance the experience of Indigenous patients receiving dialysis. PLAIN-LANGUAGE SUMMARY Worldwide Indigenous populations suffer a high incidence of chronic disease leading to lower life expectancy, particularly for kidney disease, an insidious condition requiring long-term dialysis treatment. By listening to Indigenous dialysis patients' stories, we hoped to understand how to improve their experience. We gathered 28 qualitative research studies from four countries reporting Indigenous adults' experiences of dialysis. They described lacking awareness of kidney disease, poor access to health services, systemic racism, inadequate cultural safety, and being dislocated from family, community, and culture. These findings indicate that respectful collaboration with Indigenous Peoples to craft and implement policy changes holds promise to improve prevention, integrate culturally responsive health care practices, and provide better access to local dialysis services and opportunities for kidney transplants.
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Affiliation(s)
- Marianne Kerr
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Allison Jaure
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Jacqueline H Stephens
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| | - Siah Kim
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Richard Cutler
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Brydee Cashmore
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Michelle Dickson
- Poche Centre for Indigenous Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Nicole Evangelidis
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Jaquelyne T Hughes
- College of Medicine and Public Health, Rural and Remote Health, Flinders University, Adelaide, Australia
| | - Ieyesha Roberts
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Nicole Scholes-Robertson
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Victoria Sinka
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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7
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Bellos I, Marinaki S, Samoli E, Boletis IN, Benetou V. Sociodemographic Disparities in Adults with Kidney Failure: A Meta-Analysis. Diseases 2024; 12:23. [PMID: 38248374 PMCID: PMC10813962 DOI: 10.3390/diseases12010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
This meta-analysis aims to assess current evidence regarding sociodemographic disparities among adults with kidney failure. Medline, Scopus, Web of Science, CENTRAL, and Google Scholar were systematically searched from inception to 20 February 2022. Overall, 165 cohort studies were included. Compared to White patients, dialysis survival was significantly better among Black (hazard ratio-HR: 0.68; 95% CI: 0.61-0.75), Asian (HR: 0.67; 95% CI: 0.61-0.72) and Hispanic patients (HR: 0.80; 95% CI: 0.73-0.88). Black individuals were associated with lower rates of successful arteriovenous fistula use, peritoneal dialysis and kidney transplantation, as well as with worse graft survival. Overall survival was significantly better in females after kidney transplantation compared to males (HR: 0.87; 95% CI: 0.84-0.90). Female sex was linked to higher rates of central venous catheter use and a lower probability of kidney transplantation. Indices of low SES were associated with higher mortality risk (HR: 1.22, 95% CI: 1.14-1.31), reduced rates of dialysis with an arteriovenous fistula, peritoneal dialysis and kidney transplantation, as well as higher graft failure risk. In conclusion, Black, Asian and Hispanic patients present better survival in dialysis, while Black, female and socially deprived patients demonstrate lower rates of successful arteriovenous fistula use and limited access to kidney transplantation. PROSPERO registration: CRD42022300839.
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Affiliation(s)
- Ioannis Bellos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.S.); (V.B.)
| | - Smaragdi Marinaki
- Department of Nephrology and Renal Transplantation, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.M.); (I.N.B.)
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.S.); (V.B.)
| | - Ioannis N. Boletis
- Department of Nephrology and Renal Transplantation, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.M.); (I.N.B.)
| | - Vassiliki Benetou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (E.S.); (V.B.)
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8
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Balasooriya BMJK, Rajapakse J, Gallage C. A review of drinking water quality issues in remote and indigenous communities in rich nations with special emphasis on Australia. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 903:166559. [PMID: 37633366 DOI: 10.1016/j.scitotenv.2023.166559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 08/28/2023]
Abstract
This review paper examines the drinking water quality issues in remote and Indigenous communities, with a specific emphasis on Australia. Access to clean and safe drinking water is vital for the well-being of Indigenous communities worldwide, yet numerous challenges hinder their ability to obtain and maintain water security. This review focuses on the drinking water-related issues faced by Indigenous populations in countries such as the United States, Canada, New Zealand, and Australia. In the Australian context, remote and Indigenous communities encounter complex challenges related to water quality, including microbial and chemical contamination, exacerbated by climate change effects. Analysis of water quality trends in Queensland, New South Wales, Western Australia, and the Northern Territory reveals concerns regarding various pollutants with very high concentrations in the source water leading to levels exceeding recommended drinking water limits such as hardness, turbidity, fluoride, iron, and manganese levels after limited treatment facilities available in these communities. Inadequate water quality and quantity contribute to adverse health effects, particularly among Indigenous populations who may resort to sugary beverages. Addressing these challenges requires comprehensive approaches encompassing testing, funding, governance, appropriate and sustainable treatment technologies, and cultural considerations. Collaborative efforts, risk-based approaches, and improved infrastructure are essential to ensure equitable access to clean and safe drinking water for remote and Indigenous communities, ultimately improving health outcomes and promoting social equity.
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Affiliation(s)
- B M J Kalpana Balasooriya
- School of Civil and Environmental Engineering, Faculty of Engineering, Queensland University of Technology (QUT) Brisbane QLD 4001, Australia
| | - Jay Rajapakse
- School of Civil and Environmental Engineering, Faculty of Engineering, Queensland University of Technology (QUT), 2 George Street, GPO Box 2434, Brisbane, QLD 4001, Australia.
| | - Chaminda Gallage
- School of Civil and Environmental Engineering, Faculty of Engineering, Queensland University of Technology (QUT) Brisbane QLD 4001, Australia.
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Zheng J, Xue BW, Guo AH, Feng SY, Gao R, Wu SY, Liu R, Zhai LJ. Patient delay in chronic kidney disease: A qualitative study. Medicine (Baltimore) 2023; 102:e36428. [PMID: 38050199 PMCID: PMC10695617 DOI: 10.1097/md.0000000000036428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/10/2023] [Indexed: 12/06/2023] Open
Abstract
This study aimed to investigate the reasons for patient delay in chronic kidney disease (CKD) and provide a scientific basis for implementing effective interventions. With the adoption of the phenomenological method in qualitative research, semi-structured, face-to-face interviews were conducted with 14 cases, and the Colaizzi seven-step analysis method was used to analyze the interview data and refine the themes. A total of 4 themes were obtained, namely, a cognitive explanation of illness, negative psychological emotions, socioeconomic levels, and limited medical resources. The current status of patient delay in chronic kidney disease is serious, and there are various reasons for it. Health management departments and healthcare providers at all levels should pay attention to this situation and provide targeted supportive interventions and health education to help patients establish the correct awareness of medical consultation and effectively improve their quality of survival.
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Affiliation(s)
- Jie Zheng
- School of Nursing, Shanxi Medical University, Shanxi, China
| | - Bo-Wen Xue
- School of Nursing, Hangzhou Normal University, Hangzhou, China
| | - Ao-Han Guo
- School of Nursing, Shanxi Medical University, Shanxi, China
| | - Sheng-Ya Feng
- School of Nursing, Shanxi Medical University, Shanxi, China
| | - Rong Gao
- School of Nursing, Shanxi Medical University, Shanxi, China
| | - Shu-Yan Wu
- School of Nursing, Shanxi Medical University, Shanxi, China
| | - Rong Liu
- School of Nursing, Shanxi Medical University, Shanxi, China
| | - Lin-Jun Zhai
- School of Nursing, Shanxi Medical University, Shanxi, China
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Cazzolli R, Sluiter A, Guha C, Huuskes B, Wong G, Craig JC, Jaure A, Scholes-Robertson N. Partnering with patients and caregivers to enrich research and care in kidney disease: values and strategies. Clin Kidney J 2023; 16:i57-i68. [PMID: 37711636 PMCID: PMC10497378 DOI: 10.1093/ckj/sfad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Indexed: 09/16/2023] Open
Abstract
Patient and caregiver involvement broadens the scope of new knowledge generated from research and can enhance the relevance, quality and impact of research on clinical practice and health outcomes. Incorporating the perspectives of people with lived experience of chronic kidney disease (CKD) affords new insights into the design of interventions, study methodology, data analysis and implementation and has value for patients, healthcare professionals and researchers alike. However, patient involvement in CKD research has been limited and data on which to inform best practice is scarce. A number of frameworks have been developed for involving patients and caregivers in research in CKD and in health research more broadly. These frameworks provide an overall conceptual structure to guide the planning and implementation of research partnerships and describe values that are essential and strategies considered best practice when working with diverse stakeholder groups. This article aims to provide a summary of the strategies most widely used to support multistakeholder partnerships, the different ways patients and caregivers can be involved in research and the methods used to amalgamate diverse and at times conflicting points of view.
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Affiliation(s)
- Rosanna Cazzolli
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Amanda Sluiter
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Chandana Guha
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Brooke Huuskes
- Centre for Cardiovascular Biology and Disease Research, School of Agriculture, Biomedicine and Environment, La Trobe University, Melbourne, VIC, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Jonathan C Craig
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Allison Jaure
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
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Jones EL, Shakespeare K, McLaughlin L, Noyes J. Understanding people's decisions when choosing or declining a kidney transplant: a qualitative evidence synthesis. BMJ Open 2023; 13:e071348. [PMID: 37562929 PMCID: PMC10423837 DOI: 10.1136/bmjopen-2022-071348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVES To synthesise qualitative research exploring patients' perspectives, experiences and factors influencing their decision-making preferences when choosing or declining kidney transplantation. DESIGN A qualitative evidence synthesis. DATA SOURCES Electronic databases were searched from 2000 to June 2021: PubMed, MEDLINE, CINAHL, Embase, PsycINFO, Web of Science, ProQuest Core Databases for Dissertations and Theses, and Google Scholar. ELIGIBILITY CRITERIA Qualitative studies exploring and reporting decision-making preferences of people with kidney disease, which reported influencing factors when choosing or declining kidney transplantation, published in English from high-income and middle-income countries. DATA EXTRACTION AND SYNTHESIS Titles were screened against the inclusion criteria. Thematic synthesis was done with the use of the Critical Appraisal Skills Programme qualitative checklist to assess study quality, and assessment of confidence in the qualitative findings was done using the Grading of Recommendation, Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative Research. FINDINGS 37 studies from 11 countries reported the perspectives of 1366 patients with kidney disease. Six descriptive themes were developed: decisional preferences influenced patients' readiness to pursue kidney transplantation, gathering sufficient information to support decision-making, navigating the kidney transplant assessment pathway, desire for kidney transplantation, opposed to kidney transplantation and uncertainties while waiting for the kidney transplant. A new enhanced theoretical model was developed to aid understanding of the complexities of decision-making in people with kidney disease, by integrating the Theory of Planned Behaviour and the Adaptive Decision Maker Framework to incorporate the novel findings. CONCLUSION The synthesis provides a better understanding of the extremely complex decision-making processes of people with kidney disease, which are aligned to their kidney transplantation preferences. Further research is needed to better understand the reasons for declining kidney transplantation, and to underpin development of personalised information, interventions and support for patients to make informed decisions when presented with kidney replacement options. PROSPERO REGISTRATION NUMBER CRD42021272588.
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Affiliation(s)
- Emma Louise Jones
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Kate Shakespeare
- Betsi Cadwaladr University Health Board, Clinical Psychology Dept, Royal Alexandra Hospital, Rhyl, UK
| | - Leah McLaughlin
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor, UK
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Resetting the relationship: decolonizing peer review of First Nations' kidney health research. Kidney Int 2022; 102:683-686. [PMID: 36150757 DOI: 10.1016/j.kint.2022.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/01/2022] [Indexed: 11/22/2022]
Abstract
Kerr et al. interpret the perspectives of First Nations People striving for kidney health within the United States, Canada, Aotearoa (New Zealand), and Australia. The urgency for First Nations Peoples' perspectives and leadership in kidney health care, research, quality reporting, and publishing was confirmed. Advancing this internationally is within scope of high-impact journals, such as Kidney International. Tracking Sovereignty is a proposed framework supporting First Nation Peoples' representation and leadership within journal submission and publication processes.
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