Mass Screening for Chronic Kidney Disease in Rural and Remote Canadian First Nations People: Methodology and Demographic Characteristics

Lavallee, Barry; Chartrand, Caroline; McLeod, Lorraine; Rigatto, Claudio; Tangri, Navdeep; Dart, Allison; Gordon, Audrey; Ophey, Stephanee; Komenda, Paul

doi:10.1186/s40697-015-0046-9

Cited by 17 publications

(24 citation statements)

References 31 publications

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“…The reasons for this are unknown, but may reflect the need for a better upstream approach and engagement for both the prevention of kidney disease (and type 2 diabetes) and its progression. In the indigenous population of Manitoba, 11 , 21 , 22 where higher rates of CKD were also reported, a greater severity of proteinuria was identified, a factor which would predict faster progression to end-stage renal disease. In Alberta, a higher incidence of end-stage renal disease was identified and predicted an increased risk of death.…”

Section: Discussionmentioning

confidence: 96%

“…Current efforts in Manitoba involve identifying opportunities for triage and screening within First Nations communities. 21 , 22 Komenda et al identified in the Finished Screening study that remote indigenous populations with less access to primary care demonstrated higher rates of treatable CKD. Replicating this model in Saskatchewan may identify geographic areas of highest need.…”

Section: Discussionmentioning

confidence: 99%

“…Current research includes development of a screening program for First Nations people within a multidisciplinary environment to identify people at risk of CKD and offering timely referral to specialized nephrology care. 21 , 22 The challenge is not only to improve delivery of kidney health programs but also the effective implementation of primary prevention initiatives to delay the onset of type 2 diabetes in First Nations people.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

A Retrospective Study of Chronic Kidney Disease Burden in Saskatchewan’s First Nations People

Thomas

Huang

McCarron

et al. 2018

Can J Kidney Health Dis

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Background:Chronic kidney disease is more prevalent among First Nations people than in non-First Nations people. Emerging research suggests that First Nations people are subject to greater disease burden than non-First Nations people.Objective:We aimed to identify the severity of chronic kidney disease and quantify the geographical challenges of obtaining kidney care by Saskatchewan’s First Nations people.Design:This study is a retrospective analysis of the provincial electronic medical record clinical database from January 2012 to December 2013.Setting:The setting involved patients followed by the Saskatchewan provincial chronic kidney care program, run out of two clinics, one in Regina, SK, and one in Saskatoon, SK.Patients:The patients included 2478 individuals (379 First Nations and 2099 non-First Nations) who were older than 18 years old, resident in Saskatchewan, and followed by the provincial chronic kidney care program. First Nations individuals were identified by their Indigenous and Northern Affairs Canada (INAC) Number.Measurements:The demographics, prevalence, cause of end-stage renal disease, severity of chronic kidney disease, use of home-based therapies, and distance traveled for care among patients are reported.Methods:Data were extracted from the clinical database used for direct patient care (the provincial electronic medical record database for the chronic kidney care program), which is prospectively managed by the health care staff. Actual distance traveled by road for each patient was estimated by a Geographic Information System Analyst in the First Nations and Inuit Health Branch of Health Canada.Results:Compared with non-First Nations, First Nations demonstrate a higher proportion of end-stage renal disease (First Nations = 33.0% vs non-First Nations = 21.4%, P < .001), earlier onset of chronic kidney disease (MFN = 56.4 years, SD = 15.1; MNFN = 70.6 years, SD = 14.7, P < .001), and higher rates of end-stage renal disease secondary to type 2 diabetes (First Nations = 66.1% vs non-First Nations = 39.0%, P < .001). First Nations people are also more likely to be on dialysis (First Nations = 69.7% vs non-First Nations = 40.2%, P < .001), use home-based therapies less frequently (First Nations = 16.2% vs non-First Nations = 25.7%; P = 003), and must travel farther for treatment (P < .001), with First Nations being more likely than non-First Nations to have to travel greater than 200 km.Limitations:Patients who are followed by their primary care provider or solely through their nephrologist’s office for their chronic kidney disease would not be included in this study. Patients who self-identify as Aboriginal or Indigenous without an INAC number would not be captured in the First Nations cohort.Conclusions:In Saskatchewan, First Nations’ burden of chronic kidney disease reveals higher severity, utilization of fewer home-based therapies, and longer travel distances than their non-First Nations counterparts. More research is required to identify innovative solutions within First Nations partnering ...

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Retrospective Study of Chronic Kidney Disease Burden in Saskatchewan’s First Nations People

Thomas

Huang

McCarron

et al. 2018

Can J Kidney Health Dis

View full text Add to dashboard Cite

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“…Although both programs recruit individuals based on their risk factors for CKD, the KEEP concentrates their efforts on black populations, while the SeeKD considered other ethnic groups (Aboriginal, Hispanic, South Asian, Asian, and African) as being a risk factor for CKD (22). Targeting individuals from high-risk ethnic groups is not uncommon given the disproportionate burden of ESRD among different ethnic groups, and such screening programs have been established in Australia (23) and Canada (24). Further, the KEEP used a limited number of risk factors (personal history of diabetes or hypertension, or a family history of diabetes, hypertension, or kidney disease) (12,22,25) compared with the SeeKD program (diabetes, hypertension, existing kidney problems, family history of kidney disease, member of high-risk ethnic population, current vascular disease, or currently using tobacco products).…”

Section: Discussionmentioning

confidence: 99%

The See Kidney Disease Targeted Screening Program for CKD

Galbraith¹,

Ronksley²,

Barnieh

et al. 2016

CJASN

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Background and objectives The effectiveness of targeted screening for identification of CKD is largely unknown. The See Kidney Disease (SeeKD) targeted screening project aimed to determine the prevalence of unrecognized CKD in Canada.Design, setting, participants, & measurements The SeeKD project was conducted across Canada using a convenience sample approach and events to identify adults with risk factors for CKD (i.e., diabetes, hypertension, vascular disease, family history of kidney problems, etc.). Participants with at least one risk factor received a point-of-care creatinine measurement to identify unrecognized CKD (CKD-Epidemiology Collaboration eGFR ,60 ml/min per 1.73 m 2 ). Baseline information included clinical characteristics, sociodemographics, and health knowledge. Semistructured telephone interviews were conducted with each Kidney Foundation of Canada branch (regionalized locations) after the screening events to characterize local screening strategies, which were subsequently categorized as individual-targeted (specifically targeting individuals at risk of CKD) and community-targeted (event in a community location in proximity to a high-risk population). We calculated the prevalence of unrecognized CKD overall, and by screening strategy.Results Between January 2011 and February 2014, 6329 Canadians participated in SeeKD screening events. Participants were predominantly female (65.3%), middle-aged (mean, 58.5 years), and the majority (88.9%) selfreported at least one risk factor for CKD. Of participants with at least one risk factor, 92.3% (n=5194) were screened, of whom 18.8% (95% confidence interval [95% CI], 17.8 to 19.9) had unrecognized CKD; the majority (13.8%) had stage 3a CKD (eGFR=45-60 ml/min per 1.73 m 2 ). The prevalence of unrecognized CKD was higher for branches with individual versus community-targeted events (21.9% [95% CI, 20.5 to 23.4] versus 14.7% [95% CI, 13.2 to 16.2]).Conclusions Targeted screening identified a high proportion of individuals with risk factors for CKD and a high prevalence of unrecognized CKD. Future research will evaluate the ability of targeted screening to promote selfmanagement behaviors addressing priorities for people with CKD.

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“…A combination of eGFR and urinary albumin-tocreatinine ratio is now the accepted method of CKD staging (6) to better reflect risk of mortality and progression. Extensively validated risk prediction equations (14,15) using these same biomarkers can be readily integrated into point of care screening algorithms, providing real time feedback to patients on their personalized risk of progression to kidney failure (16).…”

mentioning

confidence: 99%