M TIONG1,2, S THOMAS1, D FERNANDES1, S CHERIAN1
1Alice Springs Hospital, Alice Springs, Australia, 2Royal Melbourne Hospital, Parkville, Australia
Background: Indigenous Australians are disproportionately affected by end stage kidney disease (ESKD). Despite this they face significant delays being assessed and being waitlisted for kidney transplant.
Aim: This study aimed to examine the kidney transplant waitlisting process in our region, to compare the workup process between Indigenous and non-Indigenous patients, and identify major sources of delay.
Methods: We analysed the records of all patients being treated by our service who were on the kidney transplant waitlist between January 2017 and June 2018. Between group differences were used to compare the time taken to between commencement of dialysis and completion of each component of the assessment process. Patients who had more than one year between commencement of dialysis and waitlisting were further analysed for major sources of delay.
Results: 25 patients were included (20 Indigenous and 5 non-Indigenous). The median time to waitlisting for transplant after commencing dialysis was significantly longer in the Indigenous group (1215 v 264 days, p=0.032). Indigenous patients faced longer times before commencing the transplant assessment process and before completing dental assessment, tissue typing and to be reviewed by the transplant nephrologist and surgeon. 5 patients (2 Indigenous, 3 non-Indigenous) were waitlisted within one year of commencing dialysis. Among the remaining 20 patients, cardiac and systems issues were the two most common major sources of delay.
Conclusions: Indigenous patients face significantly delays accessing the kidney transplant waitlist. Cardiac assessment and systems issues are prominent sources of delay and efforts to address these areas may help to improve access and reduce inequality.
Dr Mark Tiong completed his RACP fellowship in nephrology in 2019 and is currently undertaking his PhD in the area of CKD-MBD at The Royal Melbourne Hospital and The University of Melbourne. He is also interested in Aboriginal and Torres Strait Islander health, having previously worked for the Central Australian Health Service in Alice Springs, and is also a current member of the ANZDATA Aboriginal and Torres Strait Islander Health Working Group.