A/Prof. Pedro Franca Gois1,2, Prof Bobby Chacko1,3, Dr Namrata Khanal4, A/Prof Kamal Sud5,6, Dr Ginger Chu3, Dr Scott Jones1, Dr Tim Spicer7, Dr Chandana Guha8, Mr Shyam Muthuramalingam9, Ms Jasmin Mazis10, Prof Stephen McDonald10,11,12
1Nephrology and Transplantation, John Hunter Hospital, Newcastle, Australia, 2The University of Queensland, Brisbane , Australia, 3The University of Newcastle, Newcastle, Australia, 4St Vincent's Hospital , Sydney , Australia, 5Nepean Hospital, Kingswood , Australia, 6The University of Sydney, Kingswood , Australia, 7South West Sydney Local Health District, Sydney, Australia, 8The University of Sydney, Sydney , Australia, 9South Australia Health, Marden , Australia, 10Australia and New Zealand Dialysis and Transplant Registry, Adelaide , Australia, 11Royal Adelaide Hospital, Adelaide , Australia, 12The University of Adelaide, Adelaide , Australia
Biography:
A/Prof Franca Gois is a mid-career clinician and researcher with medical training across Europe, South America, and Australia. He currently works as a Consultant Nephrologist at the John Hunter Hospital and holds a Level D academic appointment at the University of Queensland. His research spans basic, clinical, and translational nephrology, contributing to international guidelines and practice changes. He has secured national and international research funding, authored over 60 publications, and serves on editorial boards and global working groups.
Aim:
To evaluate how culturally and linguistically diverse (CALD) background and geographical remoteness interact to influence kidney replacement therapy (KRT) modality choice, particularly with respect to access to home-based therapies and pre-emptive transplantation.
Background:
CALD individuals face disparities in accessing KRT in Australia. Although most KRT patients are reported to be White, nearly one-third identify with other ethnicities. These groups differ in clinical profiles, geography, and initial KRT modality.
Methods:
We analysed data from the ANZDATA registry for non-Indigenous adults who initiated KRT in Australia from 2002-2023. Patients were grouped by place of birth: Australia/New Zealand (Aus/NZ), other English-speaking countries (CALD-English), and non-English-speaking countries (CALD-non-English). Remoteness was classified at residential postcode level as major city, regional and remote. Statistical analysis included chi-squared tests and multinomial logistic regression to assess associations between CALD status, remoteness, and initial KRT modality.
Results:
CALD-non-English individuals were more likely to reside in major cities (92%) vs. CALD-English (77.8%) and Aus/NZ (63.6%) (p<0.001). Compared with Aus/NZ, CALD-non-English individuals were less likely to commence KRT with home haemodialysis (HD) (RRR 0.71, 95%CI 0.57-0.87) or pre-emptive transplantation (RRR 0.38, 95%CI 0.32-0.44), and more likely to initiate peritoneal dialysis (PD) (RRR 1.35, 95%CI 1.28-1.41) (p<0.001). When assessing interactions between CALD groups and remoteness, using facility HD as the reference outcome, only CALD-non-English individuals living in regional areas showed a statistically significant difference in the likelihood of receiving PD as the initial KRT modality (RRR 0.80, 95%CI 0.69-0.92, p=0.002).
Conclusion:
CALD background and remoteness both shape KRT modality choice. These findings highlight differences in access to KRT modalities and call for further research and targeted strategies to improve culturally appropriate care and service availability.