Primary care key to indigenous kidney health

Systems-based approaches to identifying and managing patients with acute kidney injury (AKI), and preventing infections could improve health outcomes for indigenous Australians, say the authors of research published this week by The Medical Journal of Australia.

AKI is linked with short and long term morbidity and mortality, including progression to chronic kidney disease (CKD). The prevalence of AKI in the indigenous population has not been documented until now.

The researchers, led by the Rural Clinical School of Western Australia’s Dr Emma Griffiths, set out to describe the frequencies of AKI and of associated diagnoses in indigenous people in the Kimberley region of WA. The team analysed data from Aboriginal and Torres Strait Islander patients aged 15 years or more, who did not have end-stage kidney disease, for whom AKI was confirmed between June 1, 2009 and May 30, 2016 by an acute rise in serum creatinine levels.

They found that the overall AKI rate was 323 events per 100,000 population; 92 events (28 per cent) were in people aged 15-44. More than 50 per cent of principal diagnoses were infectious in nature, including pneumonia, infections of the skin and subcutaneous tissue, and urinary tract infections. Eighty events (34 per cent) were detected on or before the date of hospital admission. Fewer than one third of discharge summaries listed AKI as a primary or other diagnosis.

The study says the age distribution of AKI events among indigenous Australians in the Kimberley was skewed to younger groups than in the broader Australian population as recorded in the National Hospital Morbidity Database.

“Infectious conditions were common among patients, underscoring the significance of environmental determinants of health.

“One third of events in our study were detected before or on the day of hospital admission, indicating that AKI can be prevented and identified in community as well as in hospital settings. Primary care services [therefore] can play an important role in preventing community-acquired AKI and applying pathology-based criteria could improve its detection.”

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