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Gorham G, Abeyaratne A, Heard S, Moore L, George P, Kamler P, Majoni SW, Chen W, Balasubramanya B, Talukder MR, Pascoe S, Whitehead A, Sajiv C, Maple-Brown L, Kangaharan N, Cass A. Correction: Developing an integrated clinical decision support system for the early identification and management of kidney disease-building cross-sectoral partnerships. BMC Med Inform Decis Mak 2024; 24:89. [PMID: 38549150 PMCID: PMC10976764 DOI: 10.1186/s12911-024-02492-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2024] Open
Affiliation(s)
- Gillian Gorham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, 0810, Darwin, NT, PO Box 41096, Australia.
| | - Asanga Abeyaratne
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, 0810, Darwin, NT, PO Box 41096, Australia
- Department of Nephrology, Royal Darwin Hospital, Northern Territory Health, Darwin, NT, Australia
| | - Sam Heard
- Central Australian Aboriginal Congress, Aboriginal Corporation, Alice Springs, NT, Australia
| | - Liz Moore
- Aboriginal Medical Services Alliance Northern Territory, Darwin, NT, Australia
| | - Pratish George
- Department of Nephrology, Alice Springs Hospital, Northern Territory Health, Alice Springs, NT, Australia
| | - Paul Kamler
- Department of Nephrology, Royal Darwin Hospital, Northern Territory Health, Darwin, NT, Australia
| | - Sandawana William Majoni
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, 0810, Darwin, NT, PO Box 41096, Australia
- Department of Nephrology, Royal Darwin Hospital, Northern Territory Health, Darwin, NT, Australia
- Northern Territory Medical Program, Flinders University, Royal Darwin Hospital Campus, Darwin, NT, Australia
| | - Winnie Chen
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, 0810, Darwin, NT, PO Box 41096, Australia
| | - Bhavya Balasubramanya
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, 0810, Darwin, NT, PO Box 41096, Australia
| | - Mohammad Radwanur Talukder
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, 0810, Darwin, NT, PO Box 41096, Australia
| | - Sophie Pascoe
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, 0810, Darwin, NT, PO Box 41096, Australia
| | | | - Cherian Sajiv
- Department of Nephrology, Alice Springs Hospital, Northern Territory Health, Alice Springs, NT, Australia
- Northern Territory Medical Program, Flinders University, Royal Darwin Hospital Campus, Darwin, NT, Australia
| | - Louise Maple-Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, 0810, Darwin, NT, PO Box 41096, Australia
- Department of Endocrinology, Royal Darwin Hospital Northern Territory Health, Darwin, NT, Australia
| | - Nadarajah Kangaharan
- Division of Medicine, Royal Darwin Hospital Northern Territory Health, Darwin, NT, Australia
| | - Alan Cass
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, 0810, Darwin, NT, PO Box 41096, Australia
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Gorham G, Abeyaratne A, Heard S, Moore L, George P, Kamler P, Majoni SW, Chen W, Balasubramanya B, Talukder MR, Pascoe S, Whitehead A, Sajiv C, Maple Brown L, Kangaharan N, Cass A. Developing an integrated clinical decision support system for the early identification and management of kidney disease-building cross-sectoral partnerships. BMC Med Inform Decis Mak 2024; 24:69. [PMID: 38459531 PMCID: PMC10924414 DOI: 10.1186/s12911-024-02471-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/26/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND The burden of chronic conditions is growing in Australia with people in remote areas experiencing high rates of disease, especially kidney disease. Health care in remote areas of the Northern Territory (NT) is complicated by a mobile population, high staff turnover, poor communication between health services and complex comorbid health conditions requiring multidisciplinary care. AIM This paper aims to describe the collaborative process between research, government and non-government health services to develop an integrated clinical decision support system to improve patient care. METHODS Building on established partnerships in the government and Aboriginal Community-Controlled Health Service (ACCHS) sectors, we developed a novel digital clinical decision support system for people at risk of developing kidney disease (due to hypertension, diabetes, cardiovascular disease) or with kidney disease. A cross-organisational and multidisciplinary Steering Committee has overseen the design, development and implementation stages. Further, the system's design and functionality were strongly informed by experts (Clinical Reference Group and Technical Working Group), health service providers, and end-user feedback through a formative evaluation. RESULTS We established data sharing agreements with 11 ACCHS to link patient level data with 56 government primary health services and six hospitals. Electronic Health Record (EHR) data, based on agreed criteria, is automatically and securely transferred from 15 existing EHR platforms. Through clinician-determined algorithms, the system assists clinicians to diagnose, monitor and provide guideline-based care for individuals, as well as service-level risk stratification and alerts for clinically significant events. CONCLUSION Disconnected health services and separate EHRs result in information gaps and a health and safety risk, particularly for patients who access multiple health services. However, barriers to clinical data sharing between health services still exist. In this first phase, we report how robust partnerships and effective governance processes can overcome these barriers to support clinical decision making and contribute to holistic care.
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Affiliation(s)
- Gillian Gorham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Darwin, NT, 0810, Australia.
| | - Asanga Abeyaratne
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Darwin, NT, 0810, Australia
- Department of Nephrology, Royal Darwin Hospital, Northern Territory Health, Darwin, NT, Australia
| | - Sam Heard
- Central Australian Aboriginal Congress, Aboriginal Corporation, Alice Springs, NT, Australia
| | - Liz Moore
- Aboriginal Medical Services Alliance Northern Territory, Darwin, NT, Australia
| | - Pratish George
- Department of Nephrology, Alice Springs Hospital, Northern Territory Health, Alice Springs, NT, Australia
| | - Paul Kamler
- Department of Nephrology, Royal Darwin Hospital, Northern Territory Health, Darwin, NT, Australia
| | - Sandawana William Majoni
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Darwin, NT, 0810, Australia
- Department of Nephrology, Royal Darwin Hospital, Northern Territory Health, Darwin, NT, Australia
- Northern Territory Medical Program, Flinders University, Royal Darwin Hospital Campus, Darwin, NT, Australia
| | - Winnie Chen
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Darwin, NT, 0810, Australia
| | - Bhavya Balasubramanya
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Darwin, NT, 0810, Australia
| | - Mohammad Radwanur Talukder
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Darwin, NT, 0810, Australia
| | - Sophie Pascoe
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Darwin, NT, 0810, Australia
| | | | - Cherian Sajiv
- Department of Nephrology, Alice Springs Hospital, Northern Territory Health, Alice Springs, NT, Australia
- Northern Territory Medical Program, Flinders University, Royal Darwin Hospital Campus, Darwin, NT, Australia
| | - Louise Maple Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Darwin, NT, 0810, Australia
- Department of Endocrinology, Royal Darwin Hospital Northern Territory Health, Darwin, NT, Australia
| | - Nadarajah Kangaharan
- Division of Medicine, Royal Darwin Hospital Northern Territory Health, Darwin, NT, Australia
| | - Alan Cass
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Darwin, NT, 0810, Australia
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Hughes JT, Owen KJ, Kelly J, Cundale K, Majoni SW, D'Antoine M, McDonald SP. Cultural bias in kidney care and transplantation: review and recommendations to improve kidney care for Aboriginal and Torres Strait Islander people. Med J Aust 2023; 219 Suppl 8:S11-S14. [PMID: 37839026 DOI: 10.5694/mja2.52110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/31/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Jaquelyne T Hughes
- Rural and Remote Health, Flinders University, Darwin, NT
- Royal Darwin Hospital, Darwin, NT
| | - Kelli J Owen
- National Indigenous Kidney Transplantation Taskforce, South Australian Health and Medical Research Institute, Adelaide, SA
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA
| | - Janet Kelly
- Adelaide Medical School, University of Adelaide, Adelaide, SA
| | - Katie Cundale
- National Indigenous Kidney Transplantation Taskforce, South Australian Health and Medical Research Institute, Adelaide, SA
- Adelaide Medical School, University of Adelaide, Adelaide, SA
| | | | - Matilda D'Antoine
- National Indigenous Kidney Transplantation Taskforce, South Australian Health and Medical Research Institute, Adelaide, SA
| | - Stephen P McDonald
- Adelaide Medical School, University of Adelaide, Adelaide, SA
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, SA
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Birrell JM, Currie BJ, Abeyaratne A, Majoni SW, Boyd R. Socio-environmental and clinical features of invasive group A streptococcal disease in the Northern Territory of Australia. Commun Dis Intell (2018) 2023; 47. [PMID: 37817299 DOI: 10.33321/cdi.2023.47.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Indexed: 10/12/2023]
Abstract
Objective To describe the socio-environmental profile and clinical features of invasive group A streptococcal (iGAS) infections in the Northern Territory (NT) of Australia over 10 years. Methods Cases of iGAS disease diagnosed between 1 May 2011 and 30 April 2021 were retrospectively identified from the NT Notifiable Diseases System and electronic health records accessed. Remoteness of residence, socio-economic index, seasonality and clinical characteristics were recorded. Results There were 692 cases of iGAS disease identified in the NT during the period 1 May 2011 - 30 April 2021. The age-standardised incidence of iGAS disease was significantly higher in people living in very remote (57.1 cases per 100,000 population, 95% confidence interval [95% CI]: 48.6-65.5) and remote areas (40.9 cases per 100,000 population, 95% CI: 34.7-47.2) than in outer regional areas of the NT (15.7 cases per 100,000 population, 95% CI: 13.4-17.9). People with socio-economic disadvantage were also disproportionately affected, with an incidence of 52.6 cases per 100,000 population (95% CI: 46.2-58.9) in decile 1-3 populations, compared to 8.9 cases per 100,000 population (95% CI: 6.9-10.9) for decile 7-10. For cases with recorded severity data, 135 of 378 (36%) met locally-defined criteria for severe iGAS disease. Recurrent iGAS disease was commonly observed in the dialysis cohort, affecting 17 of the 106 patients during the study period (16% recurrence rate) and causing two deaths. Five molecularly-confirmed clusters of iGAS disease were identified from the study period. Conclusions iGAS disease is unevenly affecting people in the NT. Those living in areas of socio-economic disadvantage, those in remote and very remote communities, and those receiving dialysis were most affected. It is important that primordial, primary and secondary prevention measures be directed towards supporting these disadvantaged population groups.
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Affiliation(s)
- Johanna M Birrell
- Northern Territory Centre for Disease Control, NT Health, Darwin, NT.
| | - Bart J Currie
- Menzies School of Health Research, Charles Darwin University, Darwin, NT; Northern Territory Medical Program, Royal Darwin Hospital, Darwin, NT
| | - Asanga Abeyaratne
- Menzies School of Health Research, Charles Darwin University, Darwin, NT; Northern Territory Medical Program, Royal Darwin Hospital, Darwin, NT
| | - Sandawana William Majoni
- Menzies School of Health Research, Charles Darwin University, Darwin, NT; Northern Territory Medical Program, Royal Darwin Hospital, Darwin, NT
| | - Rowena Boyd
- Northern Territory Centre for Disease Control, NT Health, Darwin, NT
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Majoni SW, Nelson J, Graham J, Abeyaratne A, Fernandes DK, Cherian S, Rathnayake G, Ashford J, Hocking L, Cain H, McFarlane R, Lawton PD, Barzi F, Taylor S, Cass A. Comparison of two ferritin assay platforms to assess their level of agreement in measuring serum and plasma ferritin levels in patients with chronic kidney disease. BMC Nephrol 2023; 24:198. [PMID: 37391713 PMCID: PMC10314376 DOI: 10.1186/s12882-023-03255-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/27/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Ferritin levels are used to make decisions on therapy of iron deficiency in patients with chronic kidney disease (CKD). Hyperferritinaemia, common among patients with CKD from the Northern Territory (NT) of Australia, makes use of ferritin levels as per clinical guidelines challenging. No gold standard assay exists for measuring ferritin levels. Significant variability between results from different assays creates challenges for clinical decision-making regarding iron therapy. In the NT, different laboratories use different methods. In 2018, Territory Pathology changed the assay from Abbott ARCHITECT i1000 (AA) to Ortho-Clinical Diagnostics Vitros 7600 (OCD). This was during the planning of the INtravenous iron polymaltose for First Nations Australian patients with high FERRitin levels on haemodialysis (INFERR) clinical trial. The trial design was based on AA assay ferritin levels. We compared the two assays' level of agreement in measuring ferritin levels in CKD patients. METHODS Samples from INFERR clinical trial participants were analysed. Other samples from patients whose testing were completed the same day on OCD analyzers and run within 24 h on AA analyzers were added to ensure wide range of ferritin levels, adding statistical strength to the comparison. Ferritin levels from both assays were compared using Pearson's correlation, Bland-Altman, Deming and Passing-Bablok regression analyses. Differences between sample types, plasma and serum were assessed. RESULTS Sixty-eight and 111 (179) samples from different patients from Central Australia and Top End of Australia, respectively, were analyzed separately and in combination. The ferritin levels ranged from 3.1 µg/L to 3354 µg/L and 3 µg/L to 2170 µg/L for AA and OCD assays respectively. Using Bland-Altman, Deming and Passing-Bablok regression methods for comparison, ferritin results were consistently 36% to 44% higher with AA than OCD assays. The bias was up to 49%. AA ferritin results were the same in serum and plasma. However, OCD ferritin results were 5% higher in serum than plasma. CONCLUSIONS When making clinical decisions, using ferritin results from the same assay in patients with CKD is critical. If the assay is changed, it is essential to assess agreement between results from the new and old assays. Further studies to harmonize ferritin assays are required.
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Affiliation(s)
- Sandawana William Majoni
- Menzies School of Health Research, Charles Darwin University, Northern Territory, Darwin, Australia.
- Department of Nephrology, Royal Darwin Hospital, Division of Medicine, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia.
- Northern Territory Medical Program, Flinders University, Darwin, Northern Territory, Australia.
| | - Jane Nelson
- Menzies School of Health Research, Charles Darwin University, Northern Territory, Darwin, Australia
| | - Jessica Graham
- Menzies School of Health Research, Charles Darwin University, Northern Territory, Darwin, Australia
| | - Asanga Abeyaratne
- Menzies School of Health Research, Charles Darwin University, Northern Territory, Darwin, Australia
- Department of Nephrology, Royal Darwin Hospital, Division of Medicine, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia
- Northern Territory Medical Program, Flinders University, Darwin, Northern Territory, Australia
| | - David Kiran Fernandes
- Department of Nephrology, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Sajiv Cherian
- Menzies School of Health Research, Charles Darwin University, Northern Territory, Darwin, Australia
- Northern Territory Medical Program, Flinders University, Darwin, Northern Territory, Australia
- Department of Nephrology, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Geetha Rathnayake
- Territory Pathology, Darwin Northern Territory, Darwin, Australia
- Territory Pathology, Alice Springs, Northern Territory, Australia
| | - Jenna Ashford
- Territory Pathology, Darwin Northern Territory, Darwin, Australia
| | - Lynn Hocking
- Territory Pathology, Alice Springs, Northern Territory, Australia
| | - Heather Cain
- Territory Pathology, Darwin Northern Territory, Darwin, Australia
- Territory Pathology, Alice Springs, Northern Territory, Australia
| | - Robert McFarlane
- Territory Pathology, Darwin Northern Territory, Darwin, Australia
- Territory Pathology, Alice Springs, Northern Territory, Australia
| | - Paul Damian Lawton
- Menzies School of Health Research, Charles Darwin University, Northern Territory, Darwin, Australia
| | - Federica Barzi
- Menzies School of Health Research, Charles Darwin University, Northern Territory, Darwin, Australia
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD, Australia
| | - Sean Taylor
- Menzies School of Health Research, Charles Darwin University, Northern Territory, Darwin, Australia
- Department of Nephrology, Royal Darwin Hospital, Division of Medicine, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Northern Territory, Darwin, Australia
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Birrell JM, Boyd R, Currie BJ, Anstey NM, Abeyaratne A, Majoni SW, Krause VL. Invasive group A streptococcal disease in the Northern Territory and the impact of melioidosis antibiotic prophylaxis. Med J Aust 2022; 217:544-545. [PMID: 36172918 DOI: 10.5694/mja2.51739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022]
Affiliation(s)
| | - Rowena Boyd
- Northern Territory Centre for Disease Control, NT Health Darwin NT
| | - Bart J Currie
- Menzies School of Health Research Charles Darwin University Darwin NT
- Northern Territory Medical Program, Royal Darwin Hospital Darwin NT
| | - Nicholas M Anstey
- Menzies School of Health Research Charles Darwin University Darwin NT
- Northern Territory Medical Program, Royal Darwin Hospital Darwin NT
| | - Asanga Abeyaratne
- Menzies School of Health Research Charles Darwin University Darwin NT
- Northern Territory Medical Program, Royal Darwin Hospital Darwin NT
| | - Sandawana William Majoni
- Menzies School of Health Research Charles Darwin University Darwin NT
- Northern Territory Medical Program, Royal Darwin Hospital Darwin NT
| | - Vicki L Krause
- Northern Territory Centre for Disease Control, NT Health Darwin NT
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Barraclough KA, Metz D, Staatz CE, Gorham G, Carroll R, Majoni SW, Cherian S, Swaminathan R, Holford N. Important lack of difference in tacrolimus and mycophenolic acid pharmacokinetics between Aboriginal and Caucasian kidney transplant recipients. Nephrology (Carlton) 2022; 27:771-779. [PMID: 35727904 DOI: 10.1111/nep.14080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/01/2022] [Accepted: 06/15/2022] [Indexed: 11/26/2022]
Abstract
AIM To examine whether differences in tacrolimus and mycophenolic acid (MPA) pharmacokinetics contribute to the poorer kidney transplant outcomes experienced by Aboriginal Australians. METHODS Concentration-time profiles for tacrolimus and MPA were prospectively collected from 43 kidney transplant recipients: 27 Aboriginal and 16 Caucasian. Apparent clearance (CL/F) and distribution volume (V/F) for each individual were derived from concentration-time profiles combined with population pharmacokinetic priors, with subsequent assessment for between-group difference in pharmacokinetics. In addition, population pharmacokinetic models were developed using the prospective dataset supplemented by previously developed structural models for tacrolimus and MPA. The change in NONMEM objective function was used to assess improvement in goodness of model fit. RESULTS No differences were found between Aboriginal and Caucasian groups or empirical Bayes estimates, for CL/F or V/F of MPA or tacrolimus. However, a higher prevalence of CYP3A5 expressers (26% compared with 0%) and wider between-subject variability in tacrolimus CL/F (SD = 5.00 compared with 3.25 L/h/70 kg) were observed in the Aboriginal group, though these differences failed to reach statistical significance (p = .07 and p = .08). CONCLUSION There were no differences in typical tacrolimus or MPA pharmacokinetics between Aboriginal and Caucasian kidney transplant recipients. This means that Bayesian dosing tools developed to optimise tacrolimus and MPA dosing in Caucasian recipients may be applied to Aboriginal recipients. In turn, this may improve drug exposure and thereby transplant outcomes in this group. Aboriginal recipients appeared to have greater between-subject variability in tacrolimus CL/F and a higher prevalence of CYP3A5 expressers, attributes that have been linked with inferior outcomes.
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Affiliation(s)
- Katherine A Barraclough
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - David Metz
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Department of Nephrology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Christine E Staatz
- School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia
| | - Gillian Gorham
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Robert Carroll
- Department of Nephrology, Central Northern Adelaide Renal Transplantation Services, Adelaide, South Australia, Australia.,Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Sandawana William Majoni
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Nephrology, Northern Territory Renal Services, Darwin, Northern Territory, Australia.,School of Medicine, Flinders University Northern Territory Medical Program, Darwin, Northern Territory, Australia
| | - Sajiv Cherian
- Renal Services, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | | | - Nick Holford
- Pharmacology and Clinical Pharmacology, University of Auckland, Auckland, New Zealand
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Majoni SW, Nelson J, Germaine D, Hoppo L, Long S, Divakaran S, Turner B, Graham J, Cherian S, Pawar B, Rathnayake G, Heron B, Maple-Brown L, Batey R, Morris P, Davies J, Fernandes DK, Sundaram M, Abeyaratne A, Wong YHS, Lawton PD, Taylor S, Barzi F, Cass A. INFERR-Iron infusion in haemodialysis study: INtravenous iron polymaltose for First Nations Australian patients with high FERRitin levels on haemodialysis-a protocol for a prospective open-label blinded endpoint randomised controlled trial. Trials 2021; 22:868. [PMID: 34857020 PMCID: PMC8641231 DOI: 10.1186/s13063-021-05854-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 11/20/2021] [Indexed: 11/14/2022] Open
Abstract
Background The effectiveness of erythropoiesis-stimulating agents, which are the main stay of managing anaemia of chronic kidney disease (CKD), is largely dependent on adequate body iron stores. The iron stores are determined by the levels of serum ferritin concentration and transferrin saturation. These two surrogate markers of iron stores are used to guide iron replacement therapy. Most Aboriginal and/or Torres Islander Australians of the Northern Territory (herein respectfully referred to as First Nations Australians) with end-stage kidney disease have ferritin levels higher than current guideline recommendations for iron therapy. There is no clear evidence to guide safe and effective treatment with iron in these patients. We aim to assess the impact of intravenous iron treatment on all-cause death and hospitalisation with a principal diagnosis of all-cause infection in First Nations patients on haemodialysis with anaemia, high ferritin levels and low transferrin saturation Methods In a prospective open-label blinded endpoint randomised controlled trial, a total of 576 participants on maintenance haemodialysis with high ferritin (> 700 μg/L and ≤ 2000 μg/L) and low transferrin saturation (< 40%) from all the 7 renal units across the Northern Territory of Australia will be randomised 1:1 to receive intravenous iron polymaltose 400 mg once monthly (200 mg during 2 consecutive haemodialysis sessions) (Arm A) or no IV iron treatment (standard treatment) (Arm B). Rescue therapy will be administered when the ferritin levels fall below 700 μg/L or when clinically indicated. The primary outcome will be the differences between the two study arms in the risk of hospitalisation with all-cause infection or death. An economic analysis and several secondary and tertiary outcomes analyses will also be performed. Discussion The INFERR clinical trial will address significant uncertainty on the safety and efficacy of iron therapy in First Nations Australians with CKD with hyperferritinaemia and evidence of iron deficiency. This will hopefully lead to the development of evidence-based guidelines. It will also provide the opportunity to explore the causes of hyperferritinaemia in First Nations Australians from the Northern Territory. Trial registration This trial is registered with The Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12620000705987. Registered 29 June 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05854-w.
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Affiliation(s)
- Sandawana William Majoni
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia. .,Department of Nephrology, Division of Medicine, Royal Darwin Hospital, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia. .,Flinders University and Northern Territory Medical Program, Royal Darwin Hospital Campus, Darwin, Northern Territory, Australia.
| | - Jane Nelson
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Darren Germaine
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Libby Hoppo
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Stephanie Long
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Shilpa Divakaran
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Nephrology, Division of Medicine, Royal Darwin Hospital, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia
| | - Brandon Turner
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jessica Graham
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Sajiv Cherian
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Flinders University and Northern Territory Medical Program, Royal Darwin Hospital Campus, Darwin, Northern Territory, Australia.,Department of Nephrology, Division of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Basant Pawar
- Department of Nephrology, Division of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Geetha Rathnayake
- Flinders University and Northern Territory Medical Program, Royal Darwin Hospital Campus, Darwin, Northern Territory, Australia.,Chemical Pathology-Territory Pathology, Department of Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Bianca Heron
- Department of Nephrology, Division of Medicine, Royal Darwin Hospital, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia
| | - Louise Maple-Brown
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Endocrinology, Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Robert Batey
- Department of Nephrology, Division of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.,New South Wales Health, St Leonards, NSW, Australia
| | - Peter Morris
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Pediatrics, Division of Women, Children and Youth, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Jane Davies
- Department of Infectious Diseases, Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - David Kiran Fernandes
- Department of Nephrology, Division of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Madhivanan Sundaram
- Department of Nephrology, Division of Medicine, Royal Darwin Hospital, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia
| | - Asanga Abeyaratne
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Nephrology, Division of Medicine, Royal Darwin Hospital, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia.,Flinders University and Northern Territory Medical Program, Royal Darwin Hospital Campus, Darwin, Northern Territory, Australia
| | - Yun Hui Sheryl Wong
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Nephrology, Division of Medicine, Royal Darwin Hospital, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia
| | - Paul D Lawton
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,The Central Clinical School, Monash University & Alfred Health, Melbourne, Australia
| | - Sean Taylor
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Nephrology, Division of Medicine, Royal Darwin Hospital, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia
| | - Federica Barzi
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,UQ Poche Centre for Indigenous Health, The University of Queensland, St Lucia, Queensland, 4067, Australia
| | - Alan Cass
- Division of Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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Xu BC, Abeyaratne A, Wong YHS, Majoni SW. Benefit and harm of anticoagulation in the prevention of thromboembolic stroke for non- valvular atrial fibrillation in haemodialysis patients - a Top End of Northern Australia study. Intern Med J 2021; 53:517-524. [PMID: 34748260 DOI: 10.1111/imj.15605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/19/2021] [Accepted: 10/26/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Warfarin for the prevention of non-valvular atrial fibrillation related thromboembolic stroke in patients on maintenance haemodialysis is controversial. Despite the exclusion of haemodialysis patients in randomised control trials, the American Heart Association/American College of Cardiology has recommended warfarin in high-risk AF patients. AIM We retrospectively examined the utility of warfarin anticoagulation therapy in our prevalent haemodialysis patients over 10 years of follow-up. METHODS Eligible patients were retrospectively identified and stratified to two cohorts based on whether warfarin was prescribed. The outcomes of interest were ischaemic stroke, haemorrhagic stroke and death from any cause. Rate ratio and cox proportional hazard regression model were compare the differences in outcome between the two cohorts. The Kaplan-Meier method was used to analyse survival. RESULTS Three ischaemic strokes and four haemorrhagic strokes occurred in the unexposed group of 166 patients over 484.44 patient-years follow-up. One ischaemic stroke and no cases of haemorrhagic stroke occurred in the exposed warfarin group of 16 patients over 39.32 patient-years of follow-up. 87% of patients in both groups were indigenous. More than 90% of each cohort was had CHA2DS2VaSc score ≥2. 101 deaths occurred in the follow-up period, ninety in the unexposed group and eleven in the warfarin group. A non-statistically significant trend towards increasing mortality was observed in the warfarin group (Hazard ratio =1.63, p=0.13). CONCLUSION This retrospective study of prevalent haemodialysis patients with co-existing history of non-valvular AF failed to demonstrate sufficient evidence for the routine use of warfarin for prophylaxis of thromboembolic stroke. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- By Chi Xu
- Department of Nephrology, Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Asanga Abeyaratne
- Department of Nephrology, Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Flinders University and Northern Territory Medical Program, Royal Darwin Hospital Campus, Darwin, Northern Territory, Australia.,Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Northern Territory, Australia
| | - Yun Hui Sheryl Wong
- Department of Nephrology, Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Sandawana William Majoni
- Department of Nephrology, Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Flinders University and Northern Territory Medical Program, Royal Darwin Hospital Campus, Darwin, Northern Territory, Australia.,Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Northern Territory, Australia
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Kerrigan V, McGrath SY, Majoni SW, Walker M, Ahmat M, Lee B, Cass A, Hefler M, Ralph AP. "The talking bit of medicine, that's the most important bit": doctors and Aboriginal interpreters collaborate to transform culturally competent hospital care. Int J Equity Health 2021; 20:170. [PMID: 34301261 PMCID: PMC8299635 DOI: 10.1186/s12939-021-01507-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background In hospitals globally, patient centred communication is difficult to practice, and interpreters are underused. Low uptake of interpreters is commonly attributed to limited interpreter availability, time constraints and that interpreter-medicated communication in healthcare is an aberration. In Australia’s Northern Territory at Royal Darwin Hospital, it is estimated around 50% of Aboriginal patients would benefit from an interpreter, yet approximately 17% get access. Recognising this contributes to a culturally unsafe system, Royal Darwin Hospital and the NT Aboriginal Interpreter Service embedded interpreters in a renal team during medical ward rounds for 4 weeks in 2019. This paper explores the attitudinal and behavioural changes that occurred amongst non-Indigenous doctors and Aboriginal language interpreters during the pilot. Methods This pilot was part of a larger Participatory Action Research study examining strategies to achieve culturally safe communication at Royal Darwin Hospital. Two Yolŋu and two Tiwi language interpreters were embedded in a team of renal doctors. Data sources included interviews with doctors, interpreters, and an interpreter trainer; reflective journals by doctors; and researcher field notes. Inductive thematic analysis, guided by critical theory, was conducted. Results Before the pilot, frustrated doctors unable to communicate effectively with Aboriginal language speaking patients acknowledged their personal limitations and criticised hospital systems that prioritized perceived efficiency over interpreter access. During the pilot, knowledge of Aboriginal cultures improved and doctors adapted their work routines including lengthening the duration of bed side consults. Furthermore, attitudes towards culturally safe communication in the hospital changed: doctors recognised the limitations of clinically focussed communication and began prioritising patient needs and interpreters who previously felt unwelcome within the hospital reported feeling valued as skilled professionals. Despite these benefits, resistance to interpreter use remained amongst some members of the multi-disciplinary team. Conclusions Embedding Aboriginal interpreters in a hospital renal team which services predominantly Aboriginal peoples resulted in the delivery of culturally competent care. By working with interpreters, non-Indigenous doctors were prompted to reflect on their attitudes which deepened their critical consciousness resulting in behaviour change. Scale up of learnings from this pilot to broader implementation in the health service is the current focus of ongoing implementation research.
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Affiliation(s)
- Vicki Kerrigan
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia.
| | - Stuart Yiwarr McGrath
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia
| | - Sandawana William Majoni
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia.,Royal Darwin Hospital, Darwin, NT, 0811, Australia.,Flinders University, Northern Territory Medical Program, Darwin, NT, 0815, Australia
| | - Michelle Walker
- Aboriginal Interpreter Service, Northern Territory Government, GPO Box 4396, Darwin, NT, 0801, Australia
| | - Mandy Ahmat
- Aboriginal Interpreter Service, Northern Territory Government, GPO Box 4396, Darwin, NT, 0801, Australia
| | - Bilawara Lee
- Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia
| | - Marita Hefler
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia
| | - Anna P Ralph
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Darwin, NT, 0811, Australia.,Royal Darwin Hospital, Darwin, NT, 0811, Australia
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Al Alawi AM, Berhane T, Majoni SW, Falhammar H. Patients characteristics and health outcomes in patients hospitalized with hypomagnesemia: a retrospective study from a single center in the Northern Territory of Australia. Intern Med J 2021; 52:1544-1553. [PMID: 34219349 DOI: 10.1111/imj.15442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 06/19/2021] [Accepted: 06/23/2021] [Indexed: 11/27/2022]
Abstract
AIM This research aimed to study the clinical and biochemical characteristics and health outcomes of patients admitted and found to have hypomagnesemia in an Australian hospital with a high proportion of Indigenous Australians. METHODS A retrospective cohort study was conducted of all patients with hypomagnesemia hospitalised between 1st August 2008 and 31st December 2014 at Royal Darwin Hospital (RDH). All relevant demographic, clinical, and biochemical were collected from patients' medical records. The hospital database was reviewed in January 2018 for mortality of all included patients. RESULTS 876 patients had been admitted with a confirmed diagnosis of hypomagnesemia during the study period, with mean follow up period of 4.0 ±2.7 years. The mean age at admission was 52.4 ± 19.1 years, 52.2% were females and, 56.5% were Indigenous Australians. Chronic kidney disease (99.7%), excessive alcohol consumption (45.7%), hypertension (43.9%), and respiratory diseases (15.0%) were the most common conditions in these patients. Hypomagnesemia was associated with prolonged length of hospital stay. Most patients did not receive treatment for hypomagnesaemia during admission. During the follow-up period, 38.6% of patients died, and the most common causes of death were malignancies (29.9%). CONCLUSION Hypomagnesemia was a common and under-treated condition in hospitalised patients and was associated with poor health outcomes. Therefore, hospitals should develop guidelines for replacing and monitoring magnesium levels during hospitalisation, achieving better outcomes. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Abdullah M Al Alawi
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman.,Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Thomas Berhane
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Sandawana William Majoni
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia.,Northern Territory Medical Program, Flinders University School of Medicine, Darwin, NT, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Henrik Falhammar
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia.,Department of Endocrinology, Metabolism, and Diabetes, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.,Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
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Kerrigan V, McGrath SY, Majoni SW, Walker M, Ahmat M, Lee B, Cass A, Hefler M, Ralph AP. From "stuck" to satisfied: Aboriginal people's experience of culturally safe care with interpreters in a Northern Territory hospital. BMC Health Serv Res 2021; 21:548. [PMID: 34088326 PMCID: PMC8178868 DOI: 10.1186/s12913-021-06564-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, interpreters are underused by health providers in hospitals, despite 40 years of evidence documenting benefits to both patients and providers. At Royal Darwin Hospital, in Australia's Northern Territory, 60-90% of patients are Aboriginal, and 60% speak an Aboriginal language, but only approximately 17% access an interpreter. Recognising this system failure, the NT Aboriginal Interpreter Service and Royal Darwin Hospital piloted a new model with interpreters embedded in a renal team during medical ward rounds for 4 weeks in 2019. METHODS This research was embedded in a larger Participatory Action Research study examining cultural safety and communication at Royal Darwin Hospital. Six Aboriginal language speaking patients (five Yolŋu and one Tiwi), three non-Indigenous doctors and five Aboriginal interpreter staff were purposefully sampled. Data sources included participant interviews conducted in either the patient's language or English, researcher field notes from shadowing doctors, doctors' reflective journals, interpreter job logs and patient language lists. Inductive narrative analysis, guided by critical theory and Aboriginal knowledges, was conducted. RESULTS The hospital experience of Yolŋu and Tiwi participants was transformed through consistent access to interpreters who enabled patients to express their clinical and non-clinical needs. Aboriginal language-speaking patients experienced a transformation to culturally safe care. After initially reporting feeling "stuck" and disempowered when forced to communicate in English, participants reported feeling satisfied with their care and empowered by consistent access to the trusted interpreters, who shared their culture and worldviews. Interpreters also enabled providers to listen to concerns and priorities expressed by patients, which resulted in holistic care to address social determinants of health. This improved patient trajectories and reduced self-discharge rates. CONCLUSIONS A culturally unsafe system which restricted people's ability to receive equitable healthcare in their first language was overturned by embedding interpreters in a renal medical team. This research is the first to demonstrate the importance of consistent interpreter use for providing culturally safe care for Aboriginal patients in Australia.
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Affiliation(s)
- Vicki Kerrigan
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory 0811 Australia
| | - Stuart Yiwarr McGrath
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory 0811 Australia
| | - Sandawana William Majoni
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory 0811 Australia
- Royal Darwin Hospital, Darwin, Northern Territory 0811 Australia
- Flinders University, Northern Territory Medical Program, Darwin, Northern Australia 0815 Australia
| | - Michelle Walker
- Aboriginal Interpreter Service, Northern Territory Government, GPO Box 4396, Darwin, Northern Territory 0801 Australia
| | - Mandy Ahmat
- Aboriginal Interpreter Service, Northern Territory Government, GPO Box 4396, Darwin, Northern Territory 0801 Australia
| | - Bilawara Lee
- Charles Darwin University, PO Box 41096, Casuarina, NT 0811 Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory 0811 Australia
| | - Marita Hefler
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory 0811 Australia
| | - Anna P. Ralph
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory 0811 Australia
- Royal Darwin Hospital, Darwin, Northern Territory 0811 Australia
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Heraganahally SS, Silva SAMS, Howarth TP, Kangaharan N, Majoni SW. Comparison of clinical manifestation among Australian Indigenous and non- Indigenous patients presenting with pleural effusion. Intern Med J 2021; 52:1232-1241. [PMID: 33817935 DOI: 10.1111/imj.15310] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 03/24/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is sparse evidence in the literature in relation to the nature and causes of pleural effusion among Australian Indigenous population. METHODS In this retrospective study, Indigenous and non-Indigenous adults diagnosed to have pleural effusion over a two-year study period were included for comparative analysis. RESULTS Of the 314 patients, 205 (65%) were non-Indigenous and 52% were males. In comparison to non-Indigenous, the Indigenous patients were younger (50 years (IQR 39,60) vs 63 years (IQR 52,72), p<0.001), females (61% vs 41%, p=0.001), have higher prevalence of renal and cardiovascular disease and tend to have exudative effusion (93% vs 76%, p=0.032). Infections was judged to be the most common cause for effusion in both groups, more so among the Indigenous cohort. Effusion secondary to renal disease was higher (13% vs 1%, p<0.001) among Indigenous Australians, in contrast malignant effusions were higher (13% vs 4%, p=0.004) among non-Indigenous. Length of hospital stay was longer for Indigenous patients (p=0.001), and a greater proportion received renal dialysis (13% vs 1%, p<0.001). Intensive care unit (ICU) admissions rates were higher with infective etiology of pleural effusion (82% vs. 53% Indigenous & 44% vs. 39% non-Indigenous respectively). Re-presentations to hospital were higher among Indigenous patients (46% vs 33%, p=0.046) and were associated with renal and cardiac disease and malignancy in non-Indigenous. CONCLUSION There are significant differences in the way pleural effusion manifests among Australian Indigenous patients. Understanding these differences may facilitate approaches to the management and to implement strategies to reduce morbidity and mortality in this population. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Subash Shanthakumar Heraganahally
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Tiwi, Darwin, Northern Territory, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Northern Territory Medical Program, Flinders University, Darwin, Northern Territory, Australia.,Darwin Respiratory and Sleep Health, Darwin Private Hospital, Tiwi, Darwin, Northern Territory, Australia
| | - Sampathawaduge Anton Mario Shemil Silva
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Tiwi, Darwin, Northern Territory, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Northern Territory Medical Program, Flinders University, Darwin, Northern Territory, Australia
| | - Timothy Paul Howarth
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Tiwi, Darwin, Northern Territory, Australia.,College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Nadarajah Kangaharan
- Department of General Medicine, Royal Darwin Hospital, Tiwi, Darwin, Northern Territory, Australia.,NT Cardiac service, Darwin Private Hospital, Tiwi, Darwin, Northern Territory, Australia
| | - Sandawana William Majoni
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Northern Territory Medical Program, Flinders University, Darwin, Northern Territory, Australia.,Department of Nephrology, Royal Darwin Hospital, Tiwi, Darwin, Northern Territory, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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Majoni SW, Lawton PD, Rathnayake G, Barzi F, Hughes JT, Cass A. Narrative Review of Hyperferritinemia, Iron Deficiency, and the Challenges of Managing Anemia in Aboriginal and Torres Strait Islander Australians With CKD. Kidney Int Rep 2021; 6:501-512. [PMID: 33615076 PMCID: PMC7879094 DOI: 10.1016/j.ekir.2020.10.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/27/2020] [Indexed: 12/16/2022] Open
Abstract
Aboriginal and Torres Strait Islander Australians (Indigenous Australians) suffer some of the highest rates of chronic kidney disease (CKD) in the world. Among Indigenous Australians in remote areas of the Northern Territory, prevalence rates for renal replacement therapy (RRT) are up to 30 times higher than national prevalence. Anemia among patients with CKD is a common complication. Iron deficiency is one of the major causes. Iron deficiency is also one of the key causes of poor response to the mainstay of anemia therapy with erythropoiesis-stimulating agents (ESAs). Therefore, the effective management of anemia in people with CKD is largely dependent on effective identification and correction of iron deficiency. The current identification of iron deficiency in routine clinical practice is dependent on 2 surrogate markers of iron status: serum ferritin concentration and transferrin saturation (TSAT). However, questions exist regarding the use of serum ferritin concentration in people with CKD because it is an acute-phase reactant that can be raised in the context of acute and chronic inflammation. Serum ferritin concentration among Indigenous Australians receiving RRT is often markedly elevated and falls outside reference ranges within most national and international guidelines for iron therapy for people with CKD. This review explores published data on the challenges of managing anemia in Indigenous people with CKD and the need for future research on the efficacy and safety of treatment of anemia of CKD in patients with high ferritin and evidence iron deficiency.
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Affiliation(s)
- Sandawana William Majoni
- Department of Nephrology, Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- Flinders University and Northern Territory Medical Program, Royal Darwin Hospital Campus, Darwin, Northern Territory, Australia
- Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Northern Territory, Australia
| | - Paul D. Lawton
- Department of Nephrology, Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Northern Territory, Australia
| | - Geetha Rathnayake
- Flinders University and Northern Territory Medical Program, Royal Darwin Hospital Campus, Darwin, Northern Territory, Australia
- Chemical Pathology–Territory Pathology, Department of Health, Northern Territory Government, Northern Territory, Australia
| | - Federica Barzi
- Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Northern Territory, Australia
| | - Jaquelyne T. Hughes
- Department of Nephrology, Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Northern Territory, Australia
| | - Alan Cass
- Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Northern Territory, Australia
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Majoni SW, Barzi F, Hoy W, MacIsaac RJ, Cass A, Maple-Brown L, Hughes JT. Baseline liver function tests and full blood count indices and their association with progression of chronic kidney disease and renal outcomes in Aboriginal and Torres Strait Islander people: the eGFR follow- up study. BMC Nephrol 2020; 21:523. [PMID: 33261565 PMCID: PMC7709437 DOI: 10.1186/s12882-020-02185-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/24/2020] [Indexed: 12/14/2022] Open
Abstract
Background Determination of risks for chronic kidney disease (CKD) progression could improve strategies to reduce progression to ESKD. The eGFR Study recruited a cohort of adult Aboriginal and Torres Strait Islander people (Indigenous Australians) from Northern Queensland, Northern Territory and Western Australia, aiming to address the heavy CKD burden experienced within these communities. Methods Using data from the eGFR study, we explored the association of baseline liver function tests (LFTs) (alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), bilirubin and albumin) and full blood count (FBC) indices (white blood cell and red blood cell counts and haemoglobin) with annual eGFR decline and renal outcomes (first of 30% decline in eGFR with a follow-up eGFR < 60 mL/min/1.73 m2, initiation of renal replacement therapy, or renal death). Comparisons of baseline variables across eGFR categories were calculated using analysis of variance and logistic regression as appropriate. Linear and multivariable regression models were used to estimate the annual change in eGFR for changes in FBC indices and LFTs. Cox proportional hazard models were used to estimate the hazard ratio for developing renal outcome for changes in baseline FBC indices and LFTs. Results Of 547 participants, 540 had at least one baseline measure of LFTs and FBC indices. The mean age was 46.1 (14.7) years and 63.6% were female. The median follow-up was 3.1 (IQR 2.8–3.6) years. Annual decline in eGFR was associated with low serum albumin (p < 0.001) and haemoglobin (p = 0.007). After adjustment for age, gender, urine albumin/creatinine ratio, diabetes, BMI, CRP, WHR, alcohol consumption, cholesterol and triglycerides, low serum albumin (p < 0.001), haemoglobin (p = 0.012) and bilirubin (p = 0.011) were associated with annual decline in eGFR. Renal outcomes were inversely associated with serum albumin (p < 0.001), bilirubin (p = 0.012) and haemoglobin (p < 0.001) and directly with GGT (p = 0.007) and ALP (p < 0.001). Other FBC indices and LFTs were not associated with annual decline in eGFR or renal outcomes. Conclusions GGT, ALP, bilirubin, albumin and haemoglobin independently associate with renal outcomes. Contrary to findings from other studies, no association was found between renal outcomes and other FBC indices. These findings may help focus strategies to prevent disease progression in this high-risk population. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-020-02185-x.
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Affiliation(s)
- Sandawana William Majoni
- Department of Nephrology, Division of Medicine, Royal Darwin Hospital, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia. .,Flinders University and Northern Territory Medical Program, Royal Darwin Hospital Campus, Darwin, Australia. .,Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
| | - Federica Barzi
- Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Wendy Hoy
- Centre for Chronic Disease, The University of Queensland, Brisbane, St Lucia, Australia
| | - Richard J MacIsaac
- Baker Heart and Diabetes Institute, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia.,St. Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne and The University of Melbourne, Fitzroy, Victoria, Australia
| | - Alan Cass
- Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Louise Maple-Brown
- Department of Nephrology, Division of Medicine, Royal Darwin Hospital, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia.,Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Jaquelyne T Hughes
- Department of Nephrology, Division of Medicine, Royal Darwin Hospital, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia.,Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
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16
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Majoni SW, Ullah S, Collett J, Hughes JT, McDonald S. Weight change trajectories in Aboriginal and Torres Strait islander Australians after kidney transplantation: a cohort analysis using the Australia and New Zealand Dialysis and Transplant registry (ANZDATA). BMC Nephrol 2019; 20:232. [PMID: 31238893 PMCID: PMC6593536 DOI: 10.1186/s12882-019-1411-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 06/06/2019] [Indexed: 11/17/2022] Open
Abstract
Background Weight change post-kidney transplantation and its associations in Aboriginal and Torres Strait Islander Australians, a group known to have poor patient and graft outcomes, are unknown. Weight change based on body mass index in Aboriginal and Torres Strait Islander Australian recipients was compared to non- indigenous recipients. Methods We performed a cohort analysis of data from the Australia and New Zealand Dialysis and Transplant Registry for first deceased donor kidney transplant recipients between 1995 and 2014 in Australia. Weight change post-kidney transplantation was analysed by recipient ethnicity using multivariate mixed effect linear regression analysis. Results There were 343 (5.24%) Aboriginal and Torres Strait Islander Australian kidney transplants recipients from a total of 6550 recipients. They had higher pre-transplant BMI (p < 0.001), higher rates of current smokers (p < 0.001), diabetes (p < 0.001), coronary artery disease (p < 0.001), cerebrovascular disease (p = 0.011) and peripheral vascular disease (p = 0.013), ≥4 HLA mismatches (p < 0.001), graft loss (p < 0.001), mortality (p < 0.001) and rejection rates (p < 0.001). Weight increased in the first 2 years post-transplantation in both Aboriginal and Torres Strait Islander Australians and non-indigenous Australians. After adjusting for the baseline differences, weight change diverged significantly at 6, 12 and 24 months. The difference was most marked between 6 and 12 months. When stratified by pre-transplantation BMI, all groups except underweight reflected this pattern. Normal weight and obese Aboriginal and Torres Strait Islander Australian recipients had substantial increase at 12 and 24 months and overweight at 6, 12 and 24 months. The difference in BMI trajectories between Aboriginal and Torres Strait Islander Australians and non- indigenous Australian transplant recipients persisted after adjustment in multivariate mixed effect linear regression analysis. Conclusions Post-kidney transplantation weight gain in this high-risk population is substantial and greater than in non-indigenous Australians. Further studies should assess the effect of treatment factors and weight gain on transplant and recipient outcomes.
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Affiliation(s)
- Sandawana William Majoni
- Department of Nephrology, Division of Medicine, Royal Darwin Hospital, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia. .,Flinders University and Northern Territory Clinical School, Royal Darwin Hospital Campus, Darwin, Australia. .,Menzies School of Health Research Charles Darwin University, Darwin, NT, Australia.
| | - Shahid Ullah
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, SA Health and Medical Research Institute, Adelaide, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - James Collett
- Department of Nephrology, Division of Medicine, Royal Darwin Hospital, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia
| | - Jaquelyne T Hughes
- Department of Nephrology, Division of Medicine, Royal Darwin Hospital, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia.,Menzies School of Health Research Charles Darwin University, Darwin, NT, Australia
| | - Stephen McDonald
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, SA Health and Medical Research Institute, Adelaide, Australia.,Central Northern Adelaide Renal and Transplantation Services, Royal Adelaide Hospital, Adelaide, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Gorham G, Howard K, Zhao Y, Ahmed AMS, Lawton PD, Sajiv C, Majoni SW, Wood P, Conlon T, Signal S, Robinson SL, Brown S, Cass A. Cost of dialysis therapies in rural and remote Australia - a micro-costing analysis. BMC Nephrol 2019; 20:231. [PMID: 31238898 PMCID: PMC6593509 DOI: 10.1186/s12882-019-1421-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 06/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maintenance dialysis is a costly and resource intense activity. In Australia, inadequate health infrastructure and poor access to technically skilled staff can limit service provision in remote areas where many Aboriginal dialysis patients live. With most studies based on urban service provision, there is little evidence to guide service development. However permanent relocation to an urban area for treatment can have significant social and financial impacts that are poorly quantified. This study is part of a broader project to quantify the costs and benefits of dialysis service models in urban and remote locations in Australia's Northern Territory (NT). METHODS We undertook a micro-costing analysis of dialysis service delivery costs in urban, rural and remote areas in the NT from the payer perspective. Recurrent maintenance costs (salaries, consumables, facility management and transportation) as well as capital costs were included. Missing and centralised costs were standardised; results were inflated to 2017 values and reported in Australian dollars. RESULTS There was little difference between the average annual cost for urban and rural services with respective median costs of $85,919 versus $84,629. However remote service costs were higher ($120,172 - $124,492), driven by higher staff costs. The inclusion of capital costs did not add substantially to annual costs. Annual home haemodialysis costs ($42,927) were similar to other jurisdictions despite the significant differences in program delivery and payment of expenses not traditionally borne by governments. Annual peritoneal dialysis costs ($58,489) were both higher than home and in-centre haemodialysis by recent national dialysis cost studies. CONCLUSION The cost drivers for staffed services were staffing models and patient attendance rates. Staff salaries and transport costs were significantly higher in remote models of care. Opportunities to reduce expenditure exist by encouraging community supported services and employing local staff. Despite the delivery challenges of home haemodialysis including high patient attrition, the program still provides a cost benefit compared to urban staffed services. The next component of this study will examine patient health service utilisation and costs by model of care to provide a more comprehensive analysis of the overall cost of providing services in each location.
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Affiliation(s)
- G Gorham
- Renal Program, Wellbeing & Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.
| | - K Howard
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Y Zhao
- Department of Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | | | - P D Lawton
- Renal Program, Wellbeing & Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - C Sajiv
- Department of Health, Northern Territory Government, Darwin, Northern Territory, Australia.,Flinders University Northern Territory Medical Program, Darwin, Northern Territory, Australia
| | - S W Majoni
- Renal Program, Wellbeing & Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.,Department of Health, Northern Territory Government, Darwin, Northern Territory, Australia.,Flinders University Northern Territory Medical Program, Darwin, Northern Territory, Australia
| | - P Wood
- Department of Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - T Conlon
- Department of Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - S Signal
- Department of Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - S L Robinson
- Department of Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - S Brown
- Western Desert Nganampa Walytja Palyantjaku Tjutaku Northern Territory, Alice Springs, Australia
| | - A Cass
- Renal Program, Wellbeing & Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
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Hughes JT, Dembski L, Kerrigan V, Majoni SW, Lawton PD, Cass A. Gathering Perspectives - Finding Solutions for Chronic and End Stage Kidney Disease. Nephrology (Carlton) 2019; 23 Suppl 1:5-13. [PMID: 29436104 DOI: 10.1111/nep.13233] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2017] [Indexed: 11/29/2022]
Affiliation(s)
- J T Hughes
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,Division of Medicine, Royal Darwin Hospital, Darwin, Australia
| | | | - V Kerrigan
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - S W Majoni
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,Division of Medicine, Royal Darwin Hospital, Darwin, Australia.,Flinders University and Northern Territory Clinical School, Royal Darwin Hospital, Darwin, Australia
| | - P D Lawton
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - A Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
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Al Alawi AM, Majoni SW, Falhammar H. Magnesium and Human Health: Perspectives and Research Directions. Int J Endocrinol 2018; 2018:9041694. [PMID: 29849626 PMCID: PMC5926493 DOI: 10.1155/2018/9041694] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 02/22/2018] [Accepted: 03/05/2018] [Indexed: 12/13/2022] Open
Abstract
Magnesium is the fourth most abundant cation in the body. It has several functions in the human body including its role as a cofactor for more than 300 enzymatic reactions. Several studies have shown that hypomagnesemia is a common electrolyte derangement in clinical setting especially in patients admitted to intensive care unit where it has been found to be associated with increase mortality and hospital stay. Hypomagnesemia can be caused by a wide range of inherited and acquired diseases. It can also be a side effect of several medications. Many studies have reported that reduced levels of magnesium are associated with a wide range of chronic diseases. Magnesium can play important therapeutic and preventive role in several conditions such as diabetes, osteoporosis, bronchial asthma, preeclampsia, migraine, and cardiovascular diseases. This review is aimed at comprehensively collating the current available published evidence and clinical correlates of magnesium disorders.
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Affiliation(s)
- Abdullah M. Al Alawi
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sandawana William Majoni
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
- Menzies School of Health Research, Darwin, NT, Australia
- Northern Territory Medical Program, Flinders University School of Medicine, Darwin, NT, Australia
| | - Henrik Falhammar
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
- Menzies School of Health Research, Darwin, NT, Australia
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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20
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Ramanathan G, Abeyaratne A, Sundaram M, Fernandes DK, Pawar B, Perry GJ, Sajiv C, Majoni SW. Analysis of clinical presentation, pathological spectra, treatment and outcomes of biopsy-proven acute postinfectious glomerulonephritis in adult indigenous people of the Northern Territory of Australia. Nephrology (Carlton) 2017; 22:403-411. [PMID: 27062647 DOI: 10.1111/nep.12797] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/11/2016] [Accepted: 04/05/2016] [Indexed: 11/29/2022]
Abstract
AIM Acute postinfectious glomerulonephritis is common in indigenous communities in the Northern Territory, Australia. It is a major risk factor for the high prevalence of chronic kidney disease. We aimed to analyse the clinical presentation, pathological spectra, treatment and outcomes of biopsy-proven acute postinfectious glomerulonephritis in the Northern Territory. METHODS We performed a retrospective cohort analysis of all adult patients (≥18 years) who were diagnosed with acute postinfectious glomerulonephritis on native renal biopsies from 01/01/2004 to 31/05/2014. The outcome measure was end-stage renal disease requiring long-term dialysis. RESULTS Forty-three of 340 patients who had renal biopsies had acute postinfectious glomerulonephritis. Most were Aboriginals (88.4%). They had co-morbidities; diabetes mellitus (60.5%), hypertension (60.5%) and smoking (56.4%). Forty-nine per cent had multiple pathologies on biopsy. Predominant histological pattern was diffuse proliferative glomerulonephritis (72%). Main sites of infections were skin (47.6%) and upper respiratory tract infection (26.2%) with streptococcus and staphylococcus as predominant organisms. Fifty per cent of patients developed end-stage renal disease. On multivariable logistic regression analysis, those on dialysis had higher baseline creatinine (P = 0.003), higher albumin/creatinine ratio at presentation (P = 0.023), higher serum creatinine at presentation (P = 0.02) and lower estimated glomerular filtration rate at presentation (P = 0.012). CONCLUSION Overall, most patients had pre-existing pathology with superimposed acute postinfectious glomerulonephritis that led to poor outcomes in our cohort.
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Affiliation(s)
- Ganesh Ramanathan
- Department of Nephrology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Department of Nephrology, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Asanga Abeyaratne
- Department of Nephrology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Madhivanan Sundaram
- Department of Nephrology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - David Kiran Fernandes
- Department of Nephrology, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Basant Pawar
- Department of Nephrology, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Greg John Perry
- Department of Nephrology, Royal Perth Hospital, Perth, Western Australia, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Cherian Sajiv
- Department of Nephrology, Alice Springs Hospital, Alice Springs, Northern Territory, Australia.,Northern Territory Medical Programme, School of Medicine, Flinders University, Darwin, Northern Territory, Australia
| | - Sandawana William Majoni
- Department of Nephrology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Northern Territory Medical Programme, School of Medicine, Flinders University, Darwin, Northern Territory, Australia
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21
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Hughes JT, Barzi F, Hoy WE, Jones GRD, Rathnayake G, Majoni SW, Thomas MAB, Sinha A, Cass A, MacIsaac RJ, O'Dea K, Maple-Brown LJ. Bilirubin concentration is positively associated with haemoglobin concentration and inversely associated with albumin to creatinine ratio among Indigenous Australians: eGFR Study. Clin Biochem 2017; 50:1040-1047. [PMID: 28834701 DOI: 10.1016/j.clinbiochem.2017.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 08/14/2017] [Accepted: 08/19/2017] [Indexed: 11/28/2022]
Abstract
Low serum bilirubin concentrations are reported to be strongly associated with cardio-metabolic disease, but this relationship has not been reported among Indigenous Australian people who are known to be at high risk for diabetes and chronic kidney disease (CKD). HYPOTHESIS serum bilirubin will be negatively associated with markers of chronic disease, including CKD and anaemia among Indigenous Australians. METHOD A cross-sectional analysis of 594 adult Aboriginal and Torres Strait Islander (TSI) people in good health or with diabetes and markers of CKD. Measures included urine albumin: creatinine ratio (ACR), estimated glomerular filtration rate (eGFR), haemoglobin (Hb) and glycated haemoglobin (HbA1c). Diabetes was defined by medical history, medications or HbA1c≥6.5% or ≥48mmol/mol. Anaemia was defined as Hb<130g/L or <120g/L in males and females respectively. A multivariate regression analysis examining factors independently associated with log-bilirubin was performed. RESULTS Participants mean (SD) age was 45.1 (14.5) years, and included 62.5% females, 71.7% Aboriginal, 41.1% with diabetes, 16.7% with anaemia, 41% with ACR>3mg/mmol and 18.2% with eGFR<60mL/min/1.73m2. Median bilirubin concentration was lower in females than males (6 v 8μmol/L, p<0.001) and in Aboriginal than TSI participants (6 v 9.5μmol/L, p<0.001). Six factors explained 35% of the variance of log-bilirubin; Hb and cholesterol (both positively related) and ACR, triglycerides, Aboriginal ethnicity and female gender (all inversely related). CONCLUSION Serum bilirubin concentrations were positively associated with Hb and total cholesterol, and inversely associated with ACR. Further research to determine reasons explaining lower bilirubin concentrations among Aboriginal compared with TSI participants are needed.
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Affiliation(s)
- J T Hughes
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia; Department of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
| | - F Barzi
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - W E Hoy
- Centre for Chronic Disease, The University of Queensland, Australia
| | - G R D Jones
- SydPath, St Vincent's Hospital, Sydney, Australia
| | - G Rathnayake
- Territory Pathology, Department of Health, Northern Territory Government, Australia; Department of Pathology, Monash Medical Centre, Clayton, Victoria, Australia
| | - S W Majoni
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia; Department of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia; Flinders University Medical School, Northern Territory Medical Program, Darwin, Australia
| | | | - A Sinha
- Cairns Base Hospital and Diabetes Centre, Cairns, Australia
| | - A Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - R J MacIsaac
- Department of Medicine, University of Melbourne, Victoria, Australia; Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Victoria, Australia
| | - K O'Dea
- Centre for Population Health Research, University of South Australia, Australia
| | - L J Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia; Department of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Gorham G, Howard K, Togni S, Lawton P, Hughes J, Majoni SW, Brown S, Barnes S, Cass A. Economic and quality of care evaluation of dialysis service models in remote Australia: protocol for a mixed methods study. BMC Health Serv Res 2017; 17:320. [PMID: 28468619 PMCID: PMC5415781 DOI: 10.1186/s12913-017-2273-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/27/2017] [Indexed: 12/23/2022] Open
Abstract
Background Australia’s Northern Territory (NT) has the country’s highest incidence and prevalence of kidney disease. Indigenous people from remote areas suffer the heaviest disease burden. Concerns regarding cost and sustainability limit the provision of dialysis treatments in remote areas and most Indigenous people requiring dialysis relocate to urban areas. However, this dislocation of people from their family, community and support networks may prove more costly when the broader health, societal and economic consequences for the individual, family and whole of government are considered. Methods The Dialysis Models of Care Study is a large cross organisation mixed methods study. It includes a retrospective (2000–2014) longitudinal data linkage study of two NT cohorts: Renal Cohort 1- comprising approximately 2000 adults who received dialysis and Renal Cohort 2- comprising approximately 400 children of those adults. Linkage of administrative data sets from the Australian and New Zealand Dialysis and Transplant Registry, NT Departments of Health, Housing and Education by a specialist third party (SA/NT Datalink) will enable extraction of activity, financial and outcome data. Interviews with patients, clinicians and service providers, using a snowball technique, will canvass relevant issues and assist in determining the full costs and impacts of the five most used dialysis Models of Care. Discussion The study uses a mixed methods approach to investigate the quantitative and qualitative dimensions of the full costs and outcomes associated with the choice of particular dialysis models of care for any given patient. The study includes a large data linkage component that for the first time links health, housing and education data to fully analyse and evaluate the impact on patients, their families and the broader community, resulting from the relocation of people for treatment. The study will generate a large amount of activity, financial and qualitative data that will investigate health costs less directly related to dialysis treatment, costs to government such as housing and/or education and the health, social and economic outcomes experienced by patients. This approach fills an evidence gap critical to health service planners. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2273-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gillian Gorham
- Menzies School of Health Research, PO Box 41096, Casuarina, NT, 0811, Australia.
| | | | - Samantha Togni
- Menzies School of Health Research, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Paul Lawton
- Menzies School of Health Research, PO Box 41096, Casuarina, NT, 0811, Australia
| | | | | | - Sarah Brown
- Western Desert Nganampa Walytja Palyantjaku Tjutaku (WDNWPT), Alice Springs, Australia
| | - Sue Barnes
- Northern Territory Department of Housing, Darwin, Australia
| | - Alan Cass
- Menzies School of Health Research, PO Box 41096, Casuarina, NT, 0811, Australia
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Gagliardo F, Dole K, William Majoni S. IMMUNOSUPPRESSIVE DRUG ASSAYING: A CHALLENGE FOR RENAL TRANSPLANTATION. Australas Med J 2016. [DOI: 10.21767/amj.2016.2651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Floridis J, Abeyaratne A, Majoni SW. Prevalence and clinical impact of magnesium disorders in end-stage renal disease: a protocol for a systematic review. Syst Rev 2015; 4:76. [PMID: 26007218 PMCID: PMC4446798 DOI: 10.1186/s13643-015-0063-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 05/18/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Magnesium plays a key role in maintaining internal homeostasis through actions in the musculoskeletal, nervous, endocrine and cellular messenger systems. Renal excretion is the major route of magnesium elimination from the body. A positive magnesium balance would be expected in renal failure. However, a compensatory decrease in tubular reabsorption is expected to operate to maintain adequate urinary magnesium excretion even when glomerular filtration rate is very low. Patients with end-stage renal disease and those on dialysis have impaired regulatory mechanisms, predisposing them to disturbances in magnesium levels. The effects of high or low magnesium can have deleterious health outcomes, which impact on the co-morbidities and outcomes of chronic renal disease. This systematic review aims to determine the prevalence and clinical outcomes of magnesium disorders in end-stage renal disease. METHODS/DESIGN We will undertake a comprehensive search of various databases, MEDLINE, PubMED, EMBASE, Cochrane Library, Cochrane Collaboration, CIHNAL (Ebsco), Web of Science and Google Scholar, for observational studies and clinical trials on magnesium disorders in end-stage renal disease using key terms to identify papers for inclusion. Paper selection and data extraction (where appropriate) will be performed in duplicate on socio-demographic characteristics of participants, diagnosis of end-stage renal disease, magnesium levels, prevalence and clinical outcomes. An assessment of quality will be performed using a modified Newcastle-Ottawa Scale (NOS), including identification of any bias, which may influence findings. Data will be pooled together according to whether the studies were on pre-dialysis, hemodialysis or peritoneal dialysis participants. References from individual papers will also be screened as appropriate. Paper organisation and data extraction and analysis will take place using Microsoft Excel® and Stata version 13®. DISCUSSION This systematic review will represent a significant effort at pooling together information on prevalence and outcomes of magnesium disturbances amongst end-stage renal disease patients, which may guide further research and management of the disorders. PROSPERO CRD42014014354.
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Affiliation(s)
- John Floridis
- Department of Nephrology, Division of Medicine, Royal Darwin Hospital, P.O. Box 41326, Casuarina, 0811, Australia.
| | - Asanga Abeyaratne
- Flinders University and Northern Territory Clinical School, Royal Darwin Hospital Campus, Tiwi, 0810, Australia.
| | - Sandawana William Majoni
- Department of Nephrology, Division of Medicine, Royal Darwin Hospital, P.O. Box 41326, Casuarina, 0811, Australia. .,Flinders University and Northern Territory Clinical School, Royal Darwin Hospital Campus, Tiwi, 0810, Australia.
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Stewart BJ, Majoni SW. Acute exacerbation of previously undiagnosed chronic focal myositis in an Aboriginal patient on maintenance haemodialysis. BMJ Case Rep 2014; 2014:bcr-2014-205450. [PMID: 25342033 DOI: 10.1136/bcr-2014-205450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe a haemodialysis patient who presented with an exacerbation of previously undiagnosed chronic focal myositis during a hospital admission for missed dialysis and chronic foot osteomyelitis. The association of focal myositis with haemodialysis has been reported once previously, but we report the third case in our experience and argue that it is probably more common than previously appreciated. We consider a focused differential diagnosis for a diabetic dialysis patient with leg pain and discuss important features of this rare condition.
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Affiliation(s)
- Benjamin James Stewart
- Division of Medical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK Department of Nephrology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Majoni SW, Ellis JA, Hall H, Abeyaratne A, Lawton PD. Inflammation, high ferritin, and erythropoietin resistance in indigenous maintenance hemodialysis patients from the Top End of Northern Australia. Hemodial Int 2014; 18:740-50. [PMID: 24766376 DOI: 10.1111/hdi.12173] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Use of erythropoiesis-stimulating agents (ESAs) has improved the management of anemia in patients on maintenance hemodialysis (MHD). Iron deficiency and inflammation cause ESAs resistance and are both common among indigenous people of Northern Australia. As part of quality assurance in our Renal Anaemia Management program, we observed that there was use of higher doses of ESAs and adjuvant iron therapy in our MHD patients. This study aimed to explore the relationship among iron studies, inflammation, ESA responsiveness, and ESAs and iron requirements in indigenous patients on MHD from the Top End of Northern Australia. We performed a retrospective cohort analysis of anemia management in a cohort of our patients on MHD. We extracted data for 178 indigenous and 19 non-indigenous patients from 1 March 2009 to 28 February 2010 from the Renal Anaemia Management database, which collects data prospectively in MHD patients. Ninety-nine percent of the whole sample had a ferritin level above the international guidelines threshold of >500 µg/L. Indigenous patients had higher ferritin (1534 ± 245.5 µg/L vs. 1013 ± 323.3 µg/L, P = 0.002). C-reactive protein (CRP) was high in 56.9% of the total cohort. One hundred percent of those with normal CRP had high ferritin (>500 µg/L). C-reactive protein was higher in indigenous than in non-indigenous patients. Erythropoiesis-stimulating agents hyporesponsiveness was higher in indigenous patients (P < 0.0001). There was no significant difference in ESAs hyporesponsiveness among different levels of CRP (P = 0.116), ferritin (P = 0.408), and transferrin saturation (P = 0.503). Indigenous patients required higher total iron dose (2820.30 [2000-4350] vs. 2336.12 [1912-2900], P = 0.02). There was no significant relationship between the high ferritin and CRP. In indigenous dialysis patients, iron therapy and ESAs use are higher. The high iron use is due to a lack of published evidence to guide the administration of iron in patients with high ferritin. The high ferritin and ESAs resistance could not be fully explained by inflammation and need further evaluation. Further studies are required to determine the safe use of iron and management of ESAs resistance in our hemodialysis population.
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Affiliation(s)
- Sandawana William Majoni
- Department of Nephrology, Division of Medicine, Royal Darwin Hospital, Casuarina, Northern Territory, Australia; Northern Territory Clinical School, Royal Darwin Hospital Campus, Flinders University, Tiwi, Northern Territory, Australia
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Majoni SW, Dole K, Jabbar Z, Sundram M, Perry G. Infections: The Achilles Heel of Immunosuppression for Renal Transplantation and Immunological Renal Disease Management in the Top End of Northern Australia: Case Reports. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ojneph.2012.24010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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