Implications of institutional racism in the therapeutic itinerary of people with chronic renal failure.
Ricardo Bruno Santos Ferreira, Climene Laura de Camargo, Maria Inês da Silva Barbosa and 3 others
PMID 33047552WHAT IT FOUND
Black patients with chronic renal failure were more often diagnosed during hospitalization, while white patients were more often diagnosed during outpatient care.
Only white patients had conservative follow-up and private plans. Black patients often started dialysis earlier.
Key findings
0181.8% of black participants were referred after symptoms worsened and after hospitalization, while 58.3% of white participants were referred from outpatient care.
02Among outpatient care cases, only white participants had access to Family Health Strategy follow-up (8.3%) and conservative treatment (50%).
03Only white participants underwent conservative outpatient treatment before kidney replacement therapy, and only white participants had access to private health plans.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study included only 23 adults already receiving hemodialysis at a reference hospital, so it does not represent people with acute renal failure, people with chronic renal failure not yet on dialysis, or people treated in other services. It describes patients' reported itineraries and medical-record information, not a tested intervention, so it cannot show that any care change improved diagnosis or treatment. Participants were grouped by self-declared race/skin colour, and the study does not show how institutional racism was measured or separated from income, education, and access to private health plans. Patients were approached in the waiting room before treatment, which may limit the range of experiences captured.
Declared interests
The paper does not report a conflict-of-interest or funding declaration. It states that the study came from a master's thesis and was approved by an ethics committee.
The easy way to misread this
Do not read this as evidence that a nursing intervention reduced delays. It is a qualitative study of 23 hemodialysis patients' reported paths, so it describes unequal access but does not test a treatment or show that racism alone caused each delay.