Introduction: Indigenous people experience higher rates of end-stage renal disease as well as negative predictive factors such as medical comorbidities, lower socioeconomic status, greater waitlist time, and fewer pre-emptive transplants that undermine kidney transplantation success. In addition, Indian tribal reservation-dwelling Indigenous people may also be disproportionately affected by poverty, geographical disadvantages, limited physician availability, lower health literacy and cultural beliefs that further reduce access to care. Historically, all racial minority groups have experienced higher rates of rejection events, graft failure and mortality relating to these inequalities. Recent data suggests that short-term outcomes in Indigenous people are comparable to other racial groups, but few studies have examined this effect in the northern Great Plains region.
Methods: A retrospective database review was performed to determine outcomes of kidney transplantation in Indigenous people of the Northern Great Plains region. White and Indigenous people receiving a kidney transplant, between 2000 and 2018, at a single center, Avera McKennan Hospital in Sioux Falls, South Dakota, were included. Outcomes assessed between one month and 10 years post-transplant included estimated glomerular filtration rate, biopsy-proven acute rejection events, graft failure, patient survival, and death-censored graft failure. All transplant recipients had a minimum of one year of follow-up after transplant.
Results: A total of 622 kidney transplant recipients were included (117 Indigenous and 505 White). Indigenous recipients were more likely to smoke, have diabetes, have higher immunologic risk, receive fewer living donor kidneys, and have longer wait-list times. In the five years following kidney transplant, there were no significant differences in renal function, rejection events, cancer, graft failure or patient survival. At 10 years post-transplant, Indigenous recipients had twice the all-cause graft failure (OR 2.06; CI 1.25-3.39) and half the survival (OR 0.47; CI 0.29-0.76), however this effect was not maintained once the effect of race was adjusted for sex, smoking status, diabetes, preemptive transplant, high panel reactive antibody status and transplant type.
Conclusions: This retrospective study found that, despite differences in baseline characteristics, a population of Indigenous kidney transplant recipients at a single center in the Northern Great Plains region had no statistically significant differences in transplant outcomes in the first five years after transplant compared with their White counterparts. Racial differences emerged in graft failure and patient survival at 10 years after renal transplant, with Indigenous individuals more likely to experience negative long-term outcomes, but once covariates were adjusted for, this effect became insignificant. A number of these covariates are potentially modifiable, and a greater focus on addressing risk factor disparity could help extend the excellent five-year kidney transplant outcomes into long-term success in Indigenous people.
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Ann Fam Med
January 2025
Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
The impact of the Supreme Court of the United States ruling against race-conscious admissions extends beyond college admissions to professional schools. Based partially on the idea that enough time had elapsed for achievement of the stated goals of affirmative action, the court ruled race-conscious admissions are unconstitutional under the 14th Amendment's Equal Protection Clause. The ruling left a crack in the door to higher education, however, allowing students to write an essay showing how race or ethnicity affected their lives.
View Article and Find Full Text PDFInt J Qual Health Care
January 2025
Kimberley Renal Services, PO Box 1377, Broome, Western Australia 6725, Australia.
Background: Despite an epidemic of end-stage kidney disease in the Australian Aboriginal and Torres Strait Islander population, disparities in access to kidney transplantation persist. The journey to a successful kidney transplant is long, with an initial suitability assessment required before waitlist-specific activities begin. In an Aboriginal Community Controlled renal service, we aimed to: (i) design and implement a continuous quality improvement (CQI) approach to transplant suitability assessment, (ii) provide transplant suitability assessments for all patients of the service, (iii) describe what temporary contraindications to kidney transplantation should be the focus of health service improvements, (iv) explore participant experiences with the suitability assessment process, and (v) use our findings to inform pre- and post-transplant model of care development within Kimberley Renal Services.
View Article and Find Full Text PDFTrop Anim Health Prod
January 2025
Department of Agricultural Biotechnology, Faculty of Agriculture, Kırşehir Ahi Evran University, 40100, Kirsehir, Türkiye.
The present study was conducted on specific skeletal muscles of six weaned male kids from each of the Angora, Hair, Honamlı, and Kilis goat breeds. The relationships between the expression of myogenic factor 5 (Myf5) and myogenic factor 6 (Myf6) genes and muscle fibre characteristics were analysed. Muscle samples from the longissimus dorsi (LD) and semitendinosus (ST) were collected from six 90-day-old weaned male kids of each breed.
View Article and Find Full Text PDFAIDS Care
January 2025
Faculty of Social Work, University of Manitoba, Winnipeg, Canada.
This study explored the challenges faced by, and resilience of First Nations, Métis, and Inuit women living with HIV in Manitoba and Saskatchewan during the COVID-19 pandemic. Through a decolonizing, community-based research approach, guided by a Community Guiding Circle (CGC), interviews were conducted with 45 Indigenous women living with HIV. Participants were recruited via community outreach, peer networks, and social media.
View Article and Find Full Text PDFNurs Philos
January 2025
School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, British Columbia, Canada.
In this paper, we engage in philosophical inquiry to consider the relevance of Indigenous Knowledges (IKs) for reimagining dementia care for individuals living with dementia. We outline the limitations of philosophical perspectives aligned with Eurocentric academic knowledge, arguing that such knowledge relies on an individualistic view of self and neglects the body and embodied experience in dementia care. We demonstrate how a personal diachronicity perspective diminishes the importance of valuing the fluid and dynamic self-identities of persons living with dementia.
View Article and Find Full Text PDFEnter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!