Perspectives of Indigenous Peoples on Home Dialysis: A Systematic Review and Meta-Synthesis of Qualitative Studies

Background: Indigenous patients are less likely to be treated with home dialysis, including home hemodialysis (HHD) and peritoneal dialysis (PD), compared to non-Indigenous people. We conducted a systematic review and meta-synthesis of qualitative studies to better understand the experiences of Indigenous patients and caregivers with home dialysis. Methods: We conducted a comprehensive search of CINAHL, Cochrane, Embase, MEDLINE, and Web of Science from inception to September 13, 2023, supplemented by additional searches in Google Scholar and Health Canada resources. Data were synthesized using thematic analysis through an inductive and iterative approach. Two Indigenous community members reviewed and contextualized the findings to ensure cultural relevance. Results: Fifteen studies involving 362 participants from Canada, Australia, and New Zealand were included. Five major themes emerged: (1) delayed diagnosis and limited awareness as barriers to home dialysis; (2) Systemic and structural barriers to home dialysis; (3) the role of home dialysis in fostering autonomy and empowerment; (4) the importance of strengthening community engagement with home dialysis; and (5) proposed facilitators to improving access to home dialysis. Conclusions: While Indigenous patients and caregivers recognize the benefits of home dialysis, multiple systemic and culturally rooted barriers limit its accessibility. Meaningful engagement with Indigenous communities is essential to co-create culturally safe, community-informed strategies that promote equitable access to home dialysis and support better kidney health outcomes.