Inequities in the Care and Outcomes of Indigenous People Living With Kidney Failure

Abstract

Kidney failure, defined as end-stage kidney disease requiring kidney replacement therapy, is a public health concern that disproportionately affects indigenous peoples around the world. Despite advancements in medical technologies and preventive public health interventions in kidney care, indigenous peoples continue to face significant barriers that limit their access to care. These barriers include limited availability of kidney care services in remote areas, cultural and language obstacles, systemic racism, low health literacy, geographic isolation, and mistrust in health care systems. Such challenges contribute to notable disparities in kidney disease outcomes and kidney replacement therapy access. Previous research in countries such as Canada, Australia, New Zealand, and the United States demonstrates a disproportionate burden of risk factors, chronic kidney disease, and the consequences of kidney failure and other complications among indigenous peoples. In this review, we explore the global landscape of kidney failure among indigenous populations, examining epidemiological data, barriers to care, and outcomes of kidney replacement therapy. The key objective is to provide a comprehensive overview of disparities in the burden of kidney failure and care inequities experienced by this high-risk population group. We propose culturally sensitive, community-driven solutions to mitigate various inequities. Addressing these issues requires acknowledging and overcoming the unique challenges faced by indigenous communities, including enhancing access to home dialysis and transplantation services and implementing culturally appropriate health care practices.