Kidney360 · 2026
We Can Do Better: Preformed Dialysis Access for Aboriginal and Torres Strait Islander People: A Retrospective Cohort Analysis From the Australia and New Zealand Dialysis and Transplantation Registry 2004-2020.
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Bateman Samantha, Owen Kelli, Lester Rhanee, Pearson Odette, McDonald Stephen P, Clayton Philip, Jesudason Shilpanjali, Sinclair Nari
Аннотация
KEY POINTS: Aboriginal and Torres Strait Islander people are less likely to commence dialysis with preformed dialysis access than non-Indigenous Australians. Cocreated, culturally safe models of dialysis preparation for Aboriginal and Torres Strait Islander people are essential to improve health outcomes.
BACKGROUND: It is a priority for Aboriginal and Torres Strait Islander Australians living with kidney failure to receive best practice care. Commencing dialysis with preformed access (arteriovenous fistula, arteriovenous graft, or peritoneal dialysis catheter) is considered best practice; however, rates remain low. Data for Aboriginal and Torres Strait Islander people are limited. The aim of this study was to establish the differences in rates of preformed dialysis access between Aboriginal and Torres Strait Islander people and non-Indigenous Australians.
METHODS: Using the Australia and New Zealand Dialysis and Transplantation Registry, we considered all Australian adult people commencing chronic dialysis (January 1, 2004-December 31, 2020), comparing rates of preformed dialysis access between Aboriginal and Torres Strait Islander and non-Indigenous people, and evaluated the association with geographical remoteness and late referral.
RESULTS: Of 43,273 people commencing dialysis, 56.7% had preformed dialysis access. Aboriginal and Torres Strait Islander people were less likely to commence dialysis with preformed access (adjusted odds ratio [aOR], 0.75; 95% confidence interval [CI], 0.68 to 0.83). For Aboriginal and Torres Strait Islander people living remotely, the disparity was greater (aOR, 0.45; 95% CI, 0.32 to 0.65). Of the 20% of the cohort referred late, rates of preformed dialysis access were lowest (24.5%), but the association with ethnicity was no longer apparent (aOR, 0.87; 95% CI, 0.69 to 1.08).
CONCLUSIONS: Aboriginal and Torres Strait Islander people, especially those living remotely, are less likely to receive best-practice care when commencing dialysis. Cocreated, culturally safe models to improve dialysis preparation for Aboriginal and Torres Strait Islander people are essential to close the gap in health outcomes.
BACKGROUND: It is a priority for Aboriginal and Torres Strait Islander Australians living with kidney failure to receive best practice care. Commencing dialysis with preformed access (arteriovenous fistula, arteriovenous graft, or peritoneal dialysis catheter) is considered best practice; however, rates remain low. Data for Aboriginal and Torres Strait Islander people are limited. The aim of this study was to establish the differences in rates of preformed dialysis access between Aboriginal and Torres Strait Islander people and non-Indigenous Australians.
METHODS: Using the Australia and New Zealand Dialysis and Transplantation Registry, we considered all Australian adult people commencing chronic dialysis (January 1, 2004-December 31, 2020), comparing rates of preformed dialysis access between Aboriginal and Torres Strait Islander and non-Indigenous people, and evaluated the association with geographical remoteness and late referral.
RESULTS: Of 43,273 people commencing dialysis, 56.7% had preformed dialysis access. Aboriginal and Torres Strait Islander people were less likely to commence dialysis with preformed access (adjusted odds ratio [aOR], 0.75; 95% confidence interval [CI], 0.68 to 0.83). For Aboriginal and Torres Strait Islander people living remotely, the disparity was greater (aOR, 0.45; 95% CI, 0.32 to 0.65). Of the 20% of the cohort referred late, rates of preformed dialysis access were lowest (24.5%), but the association with ethnicity was no longer apparent (aOR, 0.87; 95% CI, 0.69 to 1.08).
CONCLUSIONS: Aboriginal and Torres Strait Islander people, especially those living remotely, are less likely to receive best-practice care when commencing dialysis. Cocreated, culturally safe models to improve dialysis preparation for Aboriginal and Torres Strait Islander people are essential to close the gap in health outcomes.