Sat. Aug 13th, 2022

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Disclosures: Kerr reports no relevant financial disclosures.

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Researchers identified five common themes among Indigenous patients with chronic kidney disease when exploring their relationship with health care, according to data published in Kidney International.

“Indigenous peoples are defined as those who first lived in a region and have distinct cultural traditions, knowledge and language which provides a basis for positive self-image and healthy identity,” Marianne Kerr, MPH, from the Center for Kidney Research at The Children’s Hospital at Westmead in Australia, and colleagues wrote. “Many Indigenous peoples with CKD experience similar challenges to the general population, however, uniquely may encounter inequitable access to responsive, culturally safe health information and services. A thematic synthesis of available qualitative research on the experience, impact, and challenges of CKD among Indigenous peoples, globally, can broaden our understanding across different First Nations groups and settings. ”

Crowd of people standing in shape of kidneys
Source: Adobe Stock

In a systematic review, researchers followed the Enhancing Transparency of Reporting the Synthesis of Qualitative Research framework to examine qualitative studies published until Oct. 7, 2021, that described the experiences and perspectives of Indigenous adults with CKD. Researchers excluded non-English studies due to possible complications with translations.

Investigators extracted data from the studies and used a consolidated criteria statement to measure how well patients’ preferences and priorities were addressed.

Among the 1,895 studies gathered, 12 were included in the final analysis. A total of 201 Indigenous patients were from the United States, Canada, Australia and New Zealand. Overall, 47% of patients had CKD that did not require kidney replacement therapy.

Researchers identified the following five themes: disadvantaged by insufficient health knowledge; discrimination in and apprehension of the health care system; fear of social disconnection; relying on relatives and kinship; and confronting barriers to transplantation.

“Collating the lived experience of Indigenous peoples with CKD from the included studies revealed many derived strengths from their kinship bonds, remaining on their homeland, and sharing their experiences through story telling. These connections facilitated self-determination and helped them face health challenges, ”Kerr and colleagues wrote. “Conversely, the effects of colonization impacted their opportunities to gain adequate health literacy, and meant they experienced discrimination in the health care system, lack of cultural safety, and barriers to treatment, collectively leading to distrust and a reluctance to seek care.”

They added, “We recommend one pathway to improve the experience of Indigenous peoples with CKD globally is to include and prioritize Indigenous voices in the development of culturally specific guidelines to minimize variations in treatment and improve health outcomes of CKD in Indigenous peoples.”

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