End-stage kidney disease among indigenous peoples of Australia and New Zealand

Abstract

Although possessing different anthropological origins, there are similarities in the epidemiology of end-stage kidney disease (ESKD) among the indigenous peoples of Australia (the Australian Aborigines and Torres Strait Islanders) and New Zealand (Maori and Pacific Peoples). In both countries there is a substantially increased rate of ESKD among these groups. This is more marked in Australia than in New Zealand, but in both countries the relative rate (in comparison to non-indigenous rates) as well as absolute rate have nearly stabilized in recent years. The excess risk affects females particularly—in contrast to the non-indigenous picture. Among Aboriginal and Torres Strait Islander people in Australia, there is a strong age interaction, with the most marked risk being among those aged 25 to 45 years. Indigenous peoples are less likely to be treated with home dialysis, and much less likely to receive a kidney transplant. In particular, rates of living donation are very low among indigenous groups in both countries. Outcomes during dialysis treatment and during transplantation are inferior to those of nonindigenous ones, even after adjustment for the higher prevalence of comorbidities. The underlying causes for these differences are complex, but the slowing and possible stabilization of incident rate changes is heartening.

“Looking back to my family”: Indigenous Australian patients’ experience of hemodialysis

“…Earlier diagnosis could reduce some of the trauma associated with unplanned start to dialysis. Some progress has been made, with late referral declining from 33.8% of Indigenous patients starting treatment in 2005 to 21.2% in 2009 [1], but delayed diagnosis remains an important concern. Improved linkages between specialist renal services and primary care in regional settings would support patients to better prepare, and more effective communication and patient education would significantly strengthen patient understanding of their situation.…”

“…In common with Indigenous populations in the US, Canada and New Zealand, Indigenous Australians have higher incidence of end-stage kidney disease (ESKD), but lower transplantation rates than their non-Indigenous counterparts [1-4]. For example, in 2005, 45.4% of non-Indigenous treated ESKD patients in Australia had a functioning transplant, compared with only 12.7% of treated Indigenous patients; corresponding figures for 2009 were 45.9% and 12.0% [1].…”

“…For example, in 2005, 45.4% of non-Indigenous treated ESKD patients in Australia had a functioning transplant, compared with only 12.7% of treated Indigenous patients; corresponding figures for 2009 were 45.9% and 12.0% [1]. Reasons for these disparities are not completely understood, but clinical factors alone do not explain them.…”

“…Most Indigenous Australian ESKD patients attend in-centre hemodialysis [1], generally in large urban centres. Many patients from regional/remote areas must leave home – often suddenly and indefinitely – to access treatment.…”

Baseline characteristics of the omega‐3 fatty acids (Fish oils) and Aspirin in Vascular access OUtcomes in REnal Disease (FAVOURED) study

“…Participants were predominantly male and Caucasian or Asian. The proportion of Indigenous participants was similar to that of the general incident haemodialysis population of ANZ . Their mean age was 54.8 ± 14.3 years.…”