Perspectives of Indigenous Peoples on Home Dialysis: A Systematic Review and Meta-Synthesis of Qualitative Studies.

KEY POINTS: Indigenous people value home dialysis as it minimizes the need for relocation while supporting autonomy, cultural connection, and community engagement. Qualitative studies highlight that barriers to home dialysis are largely systemic, structural, and culturally rooted. Community-centered and culturally informed approaches are consistently identified as key facilitators to home dialysis.

BACKGROUND

Indigenous patients are less likely to be treated with home dialysis, including home hemodialysis and peritoneal dialysis, compared with non-Indigenous people. We conducted a systematic review and meta-synthesis of qualitative studies to better understand the experiences of Indigenous patients and caregivers with home dialysis.

METHODS

We conducted a comprehensive search of Cumulative Index to Nursing and Allied Health Literature, Cochrane, Embase, MEDical Literature Analysis and Retrieval System Online, and Web of Science from inception to September 13, 2023, supplemented by additional searches in Google Scholar and Health Canada resources. Data were synthesized using thematic analysis through an inductive and iterative approach. Two Indigenous community members reviewed and contextualized the findings to ensure cultural relevance.

RESULTS

Fifteen studies involving 362 participants from Canada, Australia, and New Zealand were included. Five major themes emerged: ( 1 ) delayed diagnosis and limited awareness as barriers to home dialysis; ( 2 ) systemic and structural barriers to home dialysis; ( 3 ) the role of home dialysis in fostering autonomy and empowerment; ( 4 ) the importance of strengthening community engagement with home dialysis; and ( 5 ) proposed facilitators to improving access to home dialysis.

CONCLUSIONS

Although Indigenous patients and caregivers recognize the benefits of home dialysis, multiple systemic and culturally rooted barriers limit its accessibility. Meaningful engagement with Indigenous communities is essential to cocreate culturally safe, community-informed strategies that promote equitable access to home dialysis and support better kidney health outcomes.