These guidelines explicitly state that health systems have to measure, monitor and evaluate institutional racism and link it to cultural safety training, as well as increase community and family involvement in clinical care and equitable transport and accommodation. The guidelines recommend earlier CKD screening criteria (age ≥ 18 years) and referral to specialists services with earlier criteria of kidney function (eg, estimated glomerular filtration rate [eGFR], ≤ 45 mL/min/1.73 m2 , and a sustained decrease in eGFR, > 10 mL/min/1.73 m2 per year) compared with the general population.
Our recommendations prioritise health care service delivery changes to address institutional racism and ensure meaningful cultural safety training. Earlier detection of CKD and referral to nephrologists for First Nations Australians has been recommended to ensure timely implementation to preserve kidney function given the excess burden of disease. Finally, the importance of community with the recognition of involvement in all aspects and stages of treatment together with increased access to care on Country, particularly in rural and remote locations, including dialysis services.
结论:这些指南明确指出,卫生系统必须衡量,监督和评估机构种族主义,并将其与文化安全培训联系起来,以及增加社区和家庭参与临床护理以及公平的交通和住宿。指南建议早期的CKD筛查标准(年龄≥18岁),并转诊至具有早期肾功能标准的专家服务(例如,估计的肾小球滤过率[eGFR],≤45mL/min/1.73m2,eGFR持续下降,>10mL/min/1.73m2/年)与普通人群相比。
■我们的建议优先考虑医疗服务提供的变化,以解决机构种族主义问题,并确保有意义的文化安全培训。建议尽早检测CKD并转诊给澳大利亚原住民的肾脏病学家,以确保及时实施以保护肾脏功能,因为疾病负担过重。最后,认识到社区在治疗的所有方面和阶段的参与以及在国家/地区获得更多护理的重要性,特别是在农村和偏远地区,包括透析服务。