Haemodialysis outcomes of remote Kimberley origin Aboriginal and Torres Strait Islander patients
Why was this study done?
Over the past 20 years, there has been an epidemic of end-stage kidney disease among Aboriginal and Torres Strait Islander people in remote areas of Australia. There have been limited reports on the outcomes of Aboriginal and Torres Strait Islander people on dialysis in Australia, and those that have been published have generally documented poor patient survival when compared with non-Indigenous patients in Australia.
Satellite haemodialysis (HD) treatment has been provided in the Kimberley since the Kimberley Satellite Dialysis Centre (KSDC) opened in Oct-2002. Royal Perth Hospital (RPH) and KSDC have, between them, been responsible for the care of Kimberley patients requiring HD since that date. Therefore we wanted to:
- Describe the patients on renal replacement therapy (RRT) who originated from the Kimberley, and
- Compare the clinical outcomes and mortality rates of Aboriginal and Torres Strait Islander people of Kimberley origin receiving haemodialysis (HD) treatment with other subsets of Aboriginal and Torres Strait Islander HD patients (Northern Territory, Western Australia excluding the Kimberley region, the rest of Australia) and Australian non-Indigenous HD patients.
How was this study done?
We retrospectively identified Aboriginal and Torres Strait Islander patients of Kimberley origin and analysed secondary data from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA); this group was compared with other Australian patients receiving HD treatment from 1 January 2003 to 31 December 2007.
During the five years this study covered we found that:
- 77 Kimberley Aboriginal and Torres Strait Islander patients commenced maintenance RRT.
- The average yearly incidence for the:
- Kimberley was 1249 per million (95% CI, 1000–1560 per million).
- NT was 1215 per million (95% CI, 1090–1354 per million).
- 70% of Aboriginal and Torres Strait Islander RRT patients of Kimberley origin received HD treatment, 70% of which was provided in the Kimberley.
- KSDC was well attended: 95.7% of the 27 414 planned HD treatment sessions were attended.
- Larger proportions of all Aboriginal and Torres Strait Islander HD groups compared with non-Indigenous patients had reported comorbid conditions at the start of treatment (P < 0.0001), but the Kimberley HD group had significantly fewer reported comorbid conditions than the other Aboriginal and Torres Strait Islander HD groups (P < 0.05).
- Overall, HD patients of Kimberley origin fulfilled the CARI guidelines at least as well as other groups.
- Aboriginal and Torres Strait Islander HD patients of Kimberley origin had significantly lower crude mortality rates than all groups outside WA. The mortality rate ratio compared with non-Indigenous HD patients was 0.53 (95% CI, 0.35–0.80).
- After adjusting for age, sex, and comorbid conditions, and with or without late referral, there were no significant differences in mortality rates between the Kimberley group and other groups. The mortality rate ratio compared with non-Indigenous HD patients was 0.80 (95% CI, 0.51–1.23).
What does this mean?
This is the first report showing similar mortality rates for Aboriginal and Torres Strait Islander people exclusively from a remote area of Australia and non-Indigenous Australians receiving HD treatment. Aboriginal community control of delivery of HD treatment in a remote location in partnership with good tertiary care can result in health outcomes similar to those of non-Indigenous patients while improving quality of life. While waiting for improved prevention to reduce the numbers of patients requiring dialysis, good quality care in culturally appropriate settings is essential. The continued creative expansion of culturally safe dialysis services in rural and remote areas of Australia needs to be a central part of providing equitable care to the growing number of Aboriginal and Torres Strait Islander people with end stage kidney disease.
Publication:
Marley JV, Dent HK, Wearne M, Fitzclarence C, Nelson C, Siu K, Warr K, and Atkinson D. Haemodialysis outcomes of remote Kimberley origin Aboriginal and Torres Strait Islander patients. Med J Aust 2010; 193:516-520