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Medical Journal shines light on crisis in Indigenous kidney health

Giovanni Torre -

Recorded rates of kidney failure requiring dialysis or transplantation among Aboriginal and Torres Strait Islander people have risen over the past 40 years and are consistently higher than rates for non-Indigenous Australians, a new report reveals.

On Monday the Medical Journal of Australia published a special report highlighting the need for equity for Aboriginal and Torres Strait Islander people who require a kidney transplant and stressing the importance of engaging with Indigenous communities about their health and wellbeing needs.

"Aboriginal and Torres Strait Islander people have age-adjusted incidence rates of kidney replacement therapy — dialysis or transplantation — eight to nine times higher than those of non-Indigenous Australians, with the median age of Aboriginal and Torres Strait Islander people who experience kidney failure being nearly 30 years younger than non-Indigenous people," wrote the authors, including Professor Jaquelyne Hughes, a clinical research professor at Flinders University and a consultant nephrologist.

A 23-member National Indigenous Kidney Transplantation Taskforce (NIKTT) commissioned in 2019 has worked to improve access to the kidney transplant waiting list for Aboriginal and Torres Strait Islander peoples.

NIKTT chair, Professor Stephen McDonald, said the taskforce looked within ANZDATA (Australia and New Zealand Dialysis and Transplant Registry) to learn about presenting a data pathway of clients and clinicians working together through the transplant assessments.

"Taskforce members also said they needed local support to improve the local pathway, and NIKTT supported seven local projects with a one-year equity and access sponsorship," he said.

The NIKTT was tasked with reporting on the extent of effort to reduce cultural bias in the kidney transplant area and worked with the Lowitja Institute, which produced a cultural bias report that identified a dearth of publications. the collaborative effort highlights how future health improvements in kidney transplantation should be designed and also publicly reports on cultural bias and the steps taken by the NIKTT to mitigate cultural bias influencing access to transplantation.

NIKTT national community engagement coordinator Kelli Owen, also a co-author of Medical Journal of Australia's special kidney health report, led the establishment of a national network of Indigenous Reference Groups.

"Although there have been so many efforts to improve kidney health outcomes for Aboriginal and Torres Strait Islander people, there has not been a coordinated approach to consultation on addressing these challenges or improving service delivery," Ms Owen said.

"The key focus of the Taskforce is embedding our people's self-determination and authority into designing models of care to improve access to kidney transplantation.

"Before the establishment of the Indigenous Reference Groups, there was very limited input by Aboriginal and Torres Strait Islander consumers into the processes of care in renal units and no input about care in kidney transplant units."

Health systems across Australia need to be empowered to embrace and work with Indigenous knowledges, the authors wrote.

"For Aboriginal and Torres Strait Islander peoples living with kidney disease and after transplantation, the health system must embed true partnership, engagement and, most importantly, real change from existing verbal feedback that is backed by evidence," Ms Owen said.

Professor Hughes said: "The taskforce was a fantastic opportunity for Aboriginal and Torres Strait Islander peoples to create change they needed in health care, with the Indigenous Reference Groups carrying the voice and message of our people back to the taskforce and onwards to Canberra."

"We look forward to a commitment for continued support of the Taskforce, so that we can be sure that improved kidney health and wellbeing among all our people is seen in real improvements in people's lives and captured in routine data reporting," she said.

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