The Prevalence of CKD in Rural Canadian Indigenous Peoples: Results From the First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis (FINISHED) Screen, Triage, and Treat Program

• Published in: American journal of kidney diseases Vol. 68; no. 4; pp. 582 - 590
• Main Authors: Komenda, Paul, MD, MHA, Lavallee, Barry, MD, Ferguson, Thomas W., MSc, Tangri, Navdeep, MD, Chartrand, Caroline, RN, McLeod, Lorraine, RN, Gordon, Audrey, MBA, Dart, Allison, MD, Rigatto, Claudio, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2016
• Subjects: Adult; albuminuria; Canada; Canada - epidemiology; chronic kidney disease (CKD); Cross-Sectional Studies; early detection; estimated glomerular filtration rate (eGFR); Female; First Nations; health care access; health disparities; Humans; Indians, North American; indigenous community; Male; Mass Screening; Middle Aged; Nephrology; Prevalence; remote; renal impairment; Renal Insufficiency, Chronic - epidemiology; rural; Rural Health; Screening; Triage; urine albumin-creatinine ratio (UACR); rural; chronic kidney disease (CKD); remote; indigenous community; Screening; Canada; albuminuria; First Nations; health disparities; estimated glomerular filtration rate (eGFR); urine albumin-creatinine ratio (UACR); early detection; health care access; renal impairment
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/j.ajkd.2016.04.014

Background Indigenous Canadians have high rates of risk factors for chronic kidney disease (CKD), in particular diabetes. Furthermore, they have increased rates of complications associated with CKD, such as kidney failure and vascular disease. Our objective was to describe the prevalence of CKD in this population. Study Design Cross-sectional cohort. Setting & Participants Indigenous (First Nations) Canadians 18 years or older screened as part of the First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis (FINISHED) project, an initiative completed in 2015 that accomplished community-wide screening in 11 rural communities in Manitoba, Canada. Predictors Indigenous ethnicity and geographic location (communities accessible by road compared with those accessible only by air). Outcome Prevalence of CKD, presumed based on a single ascertainment of urine albumin-creatinine ratio (UACR) ≥ 30 mg/g and/or estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2. Measurements Kidney function measured by eGFR (CKD-EPI creatinine equation) and UACR. Results 1,346 adults were screened; 25.5% had CKD, defined as UACR ≥ 30 mg/g or eGFR < 60 mL/min/1.73 m2 . Communities accessible by road had a lower prevalence of CKD (17.6%) than more remote communities accessible only by air (34.4%). Of those screened, 3.3% had reduced kidney function (defined as eGFR < 60 mL/min/1.73 m2 ). Severely increased albuminuria was present in 5.0% of those screened. Limitations Presumption of chronicity based on a single ascertainment. There is a possibility of sampling bias, the net direction of which is uncertain. Conclusions We found a 2-fold higher prevalence of CKD in indigenous Canadians in comparison to the general population and a prevalence of severely increased albuminuria that was 5-fold higher. This is comparable to patients with diabetes and/or hypertension. Public health strategies to screen, triage, and treat all Canadian indigenous peoples with CKD should be considered.