Treatment of Australian Aboriginals with end-stage renal disease in the top end of the Northern Territory: 1978?93

Autor: Wendy E. Hoy, John D. Mathews, David J Pugsley
Rok vydání: 1995
Předmět:
Zdroj: Nephrology. 1:307-313
ISSN: 1440-1797
1320-5358
Popis: Summary: We describe the treatment of Australian Aboriginals with end-stage renal disease (ESRD) in the Top End of the Northern Territory from 1978 to 1993. Eighty-three Aboriginals and 44 non-Aboriginals were accepted into the programme. the average annual incidence of ESRD for Aboriginals in 1988–93 was 440 per million (pm), or 17.4 times that of non-Aboriginals. Aboriginals were 20 to 30 years younger than non-Aboriginals at start of treatment, and there was an excess of females, in contrast with a male excess among non-Aboriginals. Aboriginals had a higher proportion of ESRD attributed to glomerulonephritis and to diabetes, and 5% had amyloid associated with chronic infections. Most Aboriginals with ESRD received haemodialysis, and a few received peritoneal dialysis. Only 23% received transplants, compared with 48% of non-Aboriginals, and graft and patient survival after transplant was poor for Aboriginals. A sequence of non-compliance, chronic rejection, intensified immunosuppression and exacerbated co-morbidities was a common cause of death. Many Aboriginals with ESRD had serious co-morbidities, especially chronic infections and alcohol abuse; these frequently precluded transplant and were often the ultimate cause of death. Withdrawal from treatment was the cause of death in 23% of Aboriginals, compared to only 6% of non-Aboriginals, and usually reflected poor tolerance of, and compliance with, treatment and a lack of social support. High rates of albuminuria and clinical nephropathy in Aboriginals are compatible with their high ESRD rates. End stage renal disease treatment choices and outcomes are related largely to their profoundly inferior health status and socioeconomic deprivation. A 2.5-fold increase in ESRD among Aboriginals is projected by the year 2000. Precursors of ESRD must be studied, and screening and renoprotective treatment introduced, along with intensified efforts to improve the health and welfare of the entire Aboriginal population.
Databáze: OpenAIRE
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