How Haemodiafiltration impacted the cultural need of patients in the Outback?

Mrs Jane Lush¹

¹Fresenius Medical Care, Perth, Australia

Biography:

– I began my renal nursing career in the UK working in the NHS in 1999. I have since worked across public and private sectors, progressing from frontline nurse to management. My experience includes chronic in centre dialysis, acute dialysis, and satellite care. After moving to Australia in 2019, I worked in a regional dialysis unit before joining Fresenius in WA in 2021. I am passionate about improving outcomes for dialysis patients and delivering high quality, safe, and compassionate care.

Abstract:

Background

Hemodiafiltration (HDF) is an effective renal replacement therapy associated with reduced hospitalisations and improved survival compared with conventional haemodialysis (HD). As its use expands in Australia, it is important to understand how HDF may benefit Aboriginal and Torres Strait Islander patients living in remote regions, who often face cultural, personal, and logistical barriers to accessing hospital-based care. Many patients must travel long distances—sometimes up to 1,500 kilometres—for inpatient treatment, leading to long periods away from home and Country. These relocations can cause distress, disconnection from family and community, and disruption to cultural responsibilities such as caring for children, Elders, and participating in community life.

Aim

This review examines the impact of expanding HDF within Fresenius Medical Care clinics across the Northern Territory. Given the evidence that HDF reduces hospitalisation and mortality, the review explores how fewer hospital transfers may help Aboriginal and Torres Strait Islander patients remain on Country, supporting cultural, social, and family responsibilities.

Methods

A culturally appropriate questionnaire was used to engage remote community–based patients. It sought to understand how dialysis affects their daily lives, wellbeing, cultural obligations, and the significance of remaining on Country.

Results

Patients strongly expressed that receiving dialysis within their own communities is essential. Being on Country supports cultural identity, kinship, obligations to family, and overall social, emotional, and spiritual wellbeing.

Conclusion

This qualitative review highlights the importance of delivering dialysis close to home. Expanding HDF may improve clinical outcomes and reduce the need for distant hospital transfers, enabling patients to stay