Abstract
Approximately 480 million individuals worldwide (~6% of the global population) are Indigenous peoples. Despite their diverse cultures and histories, the shared legacy of colonialism has profoundly shaped their health and socioeconomic status. This legacy is deeply intertwined with poverty, systemic racism and historical trauma, contributing to significant health disparities compared with non-Indigenous populations. Among the many chronic diseases disproportionately affecting Indigenous peoples, chronic kidney disease (CKD) stands out as a major public health concern. Indigenous peoples experience higher rates of CKD, yet they often face barriers to accessing responsive and culturally safe health-care services. Factors such as geographic isolation, socioeconomic disadvantages and systemic discrimination limit their access to preventive care, early disease detection and kidney replacement therapy, leading to worse health outcomes and higher mortality rates. Exposure to environmental and occupational risks and inadequate infrastructure further exacerbate CKD risk for Indigenous peoples. Here, we examine determinants of kidney disease and health among major Indigenous populations in Africa, Asia, Australia, Canada, Latin America, Aotearoa-New Zealand, the Pacific Islands and the USA. We discuss culturally safe and responsive strategies that can improve the delivery of kidney care and make policy recommendations for multiple levels of government to ensure health-care systems are equipped to meet the needs of Indigenous communities. By addressing these gaps and promoting cultural competence in kidney care, health-care providers can have a crucial role in reducing health disparities and improving Indigenous peoples' kidney health worldwide.