PDF(Pubmed)
Abstract：
First Nations Australians display remarkable strength and resilience despite the intergenerational impacts of ongoing colonisation. The continuing disadvantage is evident in the higher incidence, prevalence, morbidity and mortality of chronic kidney disease (CKD) among First Nations Australians. Nationwide community consultation (Kidney Health Australia, Yarning Kidneys, and Lowitja Institute, Catching Some Air) identified priority issues for guideline development. These guidelines uniquely prioritised the knowledge of the community, alongside relevant evidence using an adapted GRADE Evidence to Decision framework to develop specific recommendations for the management of CKD among First Nations Australians.
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.
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.
摘要：
背景：尽管持续殖民的代际影响，澳大利亚原住民仍表现出非凡的力量和韧性。持续的缺点在发病率较高方面很明显，患病率,澳大利亚原住民慢性肾脏疾病（CKD）的发病率和死亡率。全国社区咨询（澳大利亚肾脏健康，Yarning肾脏,和Lowitja研究所,捕捉一些空气)确定了指南制定的优先问题。这些指导方针独特地优先考虑了社区的知识，以及相关证据，使用经过调整的GRADEEvidencetoDecision框架，为澳大利亚原住民的CKD管理制定具体建议。
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。
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。
