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      Chronic Kidney Disease Management – What Can We Learn from South African and Australian Efforts?

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          Background: The prevalence of chronic kidney disease is on the rise. Our objective is to describe two programs to improve the awareness and management of hypertension, renal disease, and diabetes in remote Australian Aboriginal and urban and periurban South African communities. We focus on how the Australian Aboriginal and South African Chronic Disease Outreach Programs have worked together. Methods: The establishment of prevention programs in developing countries is a challenge. The paper evaluates these challenges, including accessing international aid. The programs advocate that regular integrated checks for chronic disease and their risk factors are essential elements of regular adult health care. Programs should be run by primary health workers, following algorithms for testing and treatment, and a backup provided by nurse coordinators. Constant evaluation is essential to develop community health profiles and adapt program structure. Results: Both programs are discussed, including how they are organized to deliver preventative and treatment strategies. The challenges and adaptations required are outlined. Conclusions: It is the aim of the international kidney commu- nity to prevent chronic kidney disease. The South African and Australian groups highlight the need for a systematic and sustained approach to the management of chronic diseases to achieve this goal.

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          Most cited references 9

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          Epidemiology of end-stage renal disease: International comparisons of renal replacement therapy

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            Meeting the needs of chronically ill people.

             Nicole Wagner (2001)
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              Burden of end-stage renal disease among indigenous peoples in Australia and New Zealand.

              Rates of end-stage renal disease (ESRD) among indigenous people in Australia and New Zealand are considerably higher than the non-indigenous population. This trend, apparent for several years, is described here using data from the Australia & New Zealand Dialysis and Transplant (ANZDATA) Registry. The average age at start of renal replacement therapy (RRT) is approximately 10 years less than non-indigenous people. Among those starting RRT, rates of "diabetic nephropathy" are higher among indigenous patients, reflecting higher rates of diabetes. The increased burden of illness extends to coronary artery disease and chronic lung disease, which are present at rates 1.5 to 2 times non-indigenous rates. Once dialysis treatment has commenced, indigenous people are less likely to be placed on the active cadaveric transplant waiting list, and less likely to receive a graft. Overall mortality outcomes are poorer for indigenous patients overall, and for each RRT modality. These outcomes are not simply due to increased frequency of co-morbid illness: for indigenous people receiving dialysis treatment the mortality rate adjusted for age and gender is around 11/2 times the non-indigenous rate. These data are consistent with studies showing increased rates of markers of early renal disease (in particular albuminuria) among both Australian and New Zealand indigenous groups, and reflect a broader health profile marked by high rates of diabetes, cardiovascular disease and chronic lung disease. Addressing these issues is a major challenge for health care providers in these regions.

                Author and article information

                Blood Purif
                Blood Purification
                S. Karger AG
                December 2005
                23 December 2005
                : 24
                : 1
                : 115-122
                aDumisani Mzamane African Institute of Kidney Disease, University of the Witwatersrand, Soweto, South Africa; bKidney Disease Research and Prevention (KDRP), and Centre for Chronic Disease, University of the Queensland, Central Clinical School, Royal Brisbane Hospital, Brisbane, Australia; cGauteng Health Department, Johannesburg, South Africa
                89447 Blood Purif 2006;24:115–122
                © 2006 S. Karger AG, Basel

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                Page count
                Figures: 8, Tables: 3, References: 20, Pages: 8
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