Dr Cherian Sajiv is a Renal physician who has been working for more than 10 years with the indigenous patients of Central Australia. His clinical expertise includes general nephrology and dialysis with specific interests in indigenous renal medicine and interventional nephrology (including endovascular techniques in vascular access). He is currently the Director of Central Australian Renal Services based at the Alice Springs hospital. He is also the Clinical Director of the Northern Territory Renal Services (incorporating Darwin and the Central Australian region) and is an Adjunct Senior Lecturer with the Flinders University. He is involved in a range of collaborative clinical research activities (in indigenous health) with Menzies School of health research in the Central Australian region. ABSTRACT Kidney Disease In Central Australia Premature mortality due to cardiovascular disease, diabetes and chronic kidney disease (CKD) contribute substantially to the gap in life expectancy for Aboriginal and Torres Strait Islander Australians) indigenous Australians in the Northern Territory are 7-11 times more likely to die from chronic kidney disease and these deaths occur at a younger age than amongst non-indigenous Australians.
End-stage kidney disease (ESKD) requiring dialysis or transplant to maintain life has a major impact on the quality of life for all patients. The excess burden of disease in remote areas, both in terms of disease incidence and prevalence, and the social and cultural impact of dislocation from family and community to access necessary care, grossly amplifies this impact on Aboriginal and Torres Strait Islander peoples. More than 40% of adults attending Aboriginal primary-care services across the Central Australian region have either proteinuria or reduced kidney function-the cardinal markers of earliest stages of CKD.
The roughly 1,000,000 km² of the Central Australian region is sparsely populated and include some of the most disadvantaged regions in Australia. The Aboriginal peoples proportion of the population is high ranging from 18% in Alice Springs to 84.5% in the APY lands. In the CA region, management of chronic kidney disease and renal replacement therapy are currently provided by a range of primary, secondary and tertiary providers. The specialist renal unit based at the Alice Springs hospital provides the bulk of the services which includes care coordination in collaboration with primary-care services, renal replacement therapy (haemodialysis/peritoneal dialysis/renal transplantation work up and post transplant care), integrated management of the dialysis vascular access / interventional nephrology services based at Alice Springs hospital and shared palliative care.
The Central Australian Renal Services based (incorporating large satellite dialysis units at Flynn Drive, Tennant Creek, ASH dialysis unit) at Alice Springs also co-manage community dialysis centres and self-care dialysis in collaboration with the Western desert aboriginal Corporation (with a major focus on respite dialysis in communities and return to country programs). In addition, Fresenius Medical Care Australia manages a satellite dialysis service in Alice Springs under Republic-Private partnership with NT Health. There are a number of community-based, social welfare advocacy groups which are heavily involved in catering for and promoting the social & cultural needs of people with chronic kidney disease.
There are a number of barriers to the provision of streamlined renal care to such a culturally diverse and disadvantaged population. A collaborative approach between primary-care services and specialist renal services to reduce the incidence of end-stage kidney disease, newer and more innovative models of community-based care, improving access to and outcomes after renal transplantation and above all extensive consideration of the cultural and social needs of renal patients in Central Australia should pay rich dividends in improving outcomes of chronic kidney disease.
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