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Pollmann AS, Pinto AM, Cadieux D, Seamone CD, George SP, Smith CA, Lewis DR. Association Between Indication for Descemet Stripping Automated Endothelial Keratoplasty and Rural Residency. Cornea 2024; 43:349-355. [PMID: 37433174 PMCID: PMC10836790 DOI: 10.1097/ico.0000000000003347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/15/2023] [Accepted: 06/07/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE Residing in rural locations can be a barrier to health care access. This study investigated the impact of residing in rural and small town (RST) areas on Descemet stripping automated endothelial keratoplasty (DSAEK) indications and outcomes in Atlantic Canada. METHODS A retrospective cohort analysis examined consecutive DSAEKs performed in Nova Scotia between 2017 and 2020. Patient rurality was determined by the Statistical Area Classification system developed by Statistics Canada. Univariate and multivariate logistic regression models were used to assess for factors associated with DSAEK indication, including repeat keratoplasty, RST residence status, and travel time. RESULTS Of 271 DSAEKs during the study period, 87 (32.1%) were performed on the eyes of RST residents. The median postoperative follow-up time was 1.6 years. Undergoing DSAEK for a previous failed keratoplasty was not associated with a higher odds of RST residency (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.19-1.16; P = 0.13) but was associated with travel time (OR, 0.78 for each increasing hour of travel; 95% CI, 0.61-0.99; P = 0.044). RST residency was not associated with the occurrence of graft failure (OR, 0.48; 95% CI, 0.17-1.17; P = 0.13). CONCLUSIONS Residing in a rural area in Atlantic Canada was not associated with DSAEK graft failure. Repeat endothelial keratoplasty was associated with shorter travel time for corneal surgery but not rural residency status. Further research in this field could inform regional health strategies aimed at improving equity and accessibility to ophthalmology subspecialist care.
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Affiliation(s)
- André S. Pollmann
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada; and
| | - Ashlyn M. Pinto
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada; and
| | - Danielle Cadieux
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada; and
| | - Christopher D. Seamone
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada; and
| | - Stanley P. George
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada; and
| | - Corey A. Smith
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada; and
| | - Darrell R. Lewis
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada; and
- Herzig Eye Institute and Precision Cornea Centre, Ottawa, ON, Canada
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2
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Arunachalam V, Lea R, Hoy W, Lee S, Mott S, Savige J, Mathews JD, McMorran BJ, Nagaraj SH. Novel genetic markers for chronic kidney disease in a geographically isolated population of Indigenous Australians: Individual and multiple phenotype genome-wide association study. Genome Med 2024; 16:29. [PMID: 38347632 PMCID: PMC10860247 DOI: 10.1186/s13073-024-01299-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 01/30/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is highly prevalent among Indigenous Australians, especially those in remote regions. The Tiwi population has been isolated from mainland Australia for millennia and exhibits unique genetic characteristics that distinguish them from other Indigenous and non-Indigenous populations. Notably, the rate of end-stage renal disease is up to 20 times greater in this population compared to non-Indigenous populations. Despite the identification of numerous genetic loci associated with kidney disease through GWAS, the Indigenous population such as Tiwi remains severely underrepresented and the increased prevalence of CKD in this population may be due to unique disease-causing alleles/genes. METHODS We used albumin-to-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) to estimate the prevalence of kidney disease in the Tiwi population (N = 492) in comparison to the UK Biobank (UKBB) (N = 134,724) database. We then performed an exploratory factor analysis to identify correlations among 10 CKD-related phenotypes and identify new multi-phenotype factors. We subsequently conducted a genome-wide association study (GWAS) on all single and multiple phenotype factors using mixed linear regression models, adjusted for age, sex, population stratification, and genetic relatedness between individuals. RESULTS Based on ACR, 20.3% of the population was at severely increased risk of CKD progression and showed elevated levels of ACR compared to the UKBB population independent of HbA1c. A GWAS of ACR revealed novel association loci in the genes MEG3 (chr14:100812018:T:A), RAB36 (rs11704318), and TIAM2 (rs9689640). Additionally, multiple phenotypes GWAS of ACR, eGFR, urine albumin, and serum creatinine identified a novel variant that mapped to the gene MEIS2 (chr15:37218869:A:G). Most of the identified variants were found to be either absent or rare in the UKBB population. CONCLUSIONS Our study highlights the Tiwi population's predisposition towards elevated ACR, and the collection of novel genetic variants associated with kidney function. These associations may prove valuable in the early diagnosis and treatment of renal disease in this underrepresented population. Additionally, further research is needed to comprehensively validate the functions of the identified variants/genes.
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Affiliation(s)
- Vignesh Arunachalam
- Centre for Genomics and Personalised Health and School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Rodney Lea
- Centre for Genomics and Personalised Health and School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Wendy Hoy
- Centre of chronic disease, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Simon Lee
- Centre for Genomics and Personalised Health and School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Susan Mott
- Centre of chronic disease, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Judith Savige
- Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - John D Mathews
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Brendan J McMorran
- National Centre for Indigenous Genomics, The John Curtin of Medical Research, Australian National University, Canberra, ACT, Australia
| | - Shivashankar H Nagaraj
- Centre for Genomics and Personalised Health and School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.
- Translational Research Institute, Queensland University of Technology, Brisbane, QLD, Australia.
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Lomstein FB, Kjærgaard M, Skovgaard N, Pedersen ML, Backe MB. Reporting chronic kidney disease in Greenland. Int J Circumpolar Health 2023; 82:2261223. [PMID: 37742312 PMCID: PMC10519261 DOI: 10.1080/22423982.2023.2261223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/15/2023] [Indexed: 09/26/2023] Open
Abstract
Background: Chronic kidney disease (CKD) is a major health burden affecting more than 10% of the global population. It is a multifactorial disease with many risk factors attributed lifestyle diseases. The prevalence of CKD in Greenland is unknown; however, the prevalence of risk factors contributing to CKD is increasing.Objectives: To estimate the prevalence of CKD in Greenland.Methods: The study was a cross-sectional register-study including all Greenlandic residents aged ≥20 years with serum creatinine analysis within the last 2 years. We identified those with CKD based on eGFR and UACR and those registered with a CKD diagnosis code. Two limitations of the study are possible lack of data completeness and the reliance of a single time point to report CKD.Results: A total of 2,157 patients were identified with CKD with an age-standardised prevalence of 3.01%. Only 75 patients were registered with a diagnosis code for CKD. Approximately 80% of patients were classified with CKD stages 1-2.Conclusion: This is the first study reporting CKD in Greenland. We found a lower prevalence of CKD than reported by other studies, and a low number of patients correctly diagnosed with CKD. We call for increased awareness and diagnosis coding of CKD in Greenland.
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Affiliation(s)
- Fabian Bøgild Lomstein
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Greenland, Queen Ingrid’s Hospital, Nuuk, Greenland
| | - Marie Kjærgaard
- Department of Internal Medicine, Queen Ingrid’s Hospital, Nuuk, Greenland
- Department of Nephrology, Sygehus Lillebælt, Kolding, Denmark
| | - Nils Skovgaard
- Steno Diabetes Center Greenland, Queen Ingrid’s Hospital, Nuuk, Greenland
- Greenland’s Centre for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
| | - Michael Lynge Pedersen
- Steno Diabetes Center Greenland, Queen Ingrid’s Hospital, Nuuk, Greenland
- Greenland’s Centre for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
| | - Marie Balslev Backe
- Steno Diabetes Center Greenland, Queen Ingrid’s Hospital, Nuuk, Greenland
- Greenland’s Centre for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
- Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen, Herlev, Denmark
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Gomes OV, de Souza CDF, Nicacio JM, do Carmo RF, Pereira VC, Barral-Netto M, da Costa Armstrong A. Epidemiology of chronic kidney disease in older indigenous peoples of Brazil: findings from a cross-sectional survey. Aging Clin Exp Res 2023; 35:2201-2209. [PMID: 37517045 DOI: 10.1007/s40520-023-02510-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/16/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a prevalent disease worldwide, with increasing incidence particularly in low- and middle-income countries. Indigenous communities have poorer CKD outcomes due to limited access to healthcare. They are also experiencing a shift toward a sedentary lifestyle and urbanization-related dietary changes, increasing the risk of CKD-related risk factors. AIM To determine the prevalence of CKD in older Brazilian indigenous and identify the main associated risk factors. METHODS This cross-sectional study analyzed demographic and clinical data of 229 older indigenous individuals aged 60 years and above in 2022-2023. CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m2 or a urinary albumin-creatinine ratio > 30 mg/g. Data were presented categorically and analyzed using the Chi-square test or Fisher's exact test. RESULTS The prevalence of CKD in the population was 26.6%, with higher prevalence in women and increasing with age. The prevalence of hypertension and diabetes was 67.7% and 24.0%, respectively, and these comorbidities were associated with CKD: hypertension (OR = 5.12; 95% CI 2.2-11.9) and diabetes (OR = 5.5; 95% CI 3.7-8.2). No association was found between the prevalence of CKD and obesity, dyslipidemia, cardiovascular disease, or smoking. DISCUSSION The study found a higher prevalence of CKD among older indigenous populations in Brazil compared to non-indigenous populations, which is exacerbated by risk factors, such as aging, hypertension, diabetes, and lifestyle changes, emphasizing the importance of early detection and intervention in these communities. CONCLUSION Older persons' indigenous individuals have a high prevalence of CKD, which is correlated with factors, such as sex, age, diabetes mellitus, and hypertension.
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Affiliation(s)
- Orlando Vieira Gomes
- Postgraduate Program in Human Ecology and Socio-Environmental Management, Bahia State University-UNEB, Juazeiro, Bahia, Brazil.
- Faculty of Medicine, Federal University of Vale do São Francisco-UNIVASF, Petrolina, Pernambuco, Brazil.
| | - Carlos Dornels Freire de Souza
- Postgraduate Program in Human Ecology and Socio-Environmental Management, Bahia State University-UNEB, Juazeiro, Bahia, Brazil
- Faculty of Medicine, Federal University of Vale do São Francisco-UNIVASF, Petrolina, Pernambuco, Brazil
| | - Jandir Mendonça Nicacio
- Postgraduate Program in Human Ecology and Socio-Environmental Management, Bahia State University-UNEB, Juazeiro, Bahia, Brazil
- Faculty of Medicine, Federal University of Vale do São Francisco-UNIVASF, Petrolina, Pernambuco, Brazil
| | - Rodrigo Feliciano do Carmo
- College of Pharmaceutical Sciences, Federal University of Vale do São Francisco-UNIVASF, Petrolina, Pernambuco, Brazil
| | - Vanessa Cardoso Pereira
- Postgraduate Program in Human Ecology and Socio-Environmental Management, Bahia State University-UNEB, Juazeiro, Bahia, Brazil
| | - Manoel Barral-Netto
- Oswaldo Cruz Foundation/Fiocruz, Institute Gonçalo Moniz, Salvador, Bahia, Brazil
| | - Anderson da Costa Armstrong
- Postgraduate Program in Human Ecology and Socio-Environmental Management, Bahia State University-UNEB, Juazeiro, Bahia, Brazil
- Faculty of Medicine, Federal University of Vale do São Francisco-UNIVASF, Petrolina, Pernambuco, Brazil
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Okpechi IG, Hariramani VK, Sultana N, Ghimire A, Zaidi D, Muneer S, Tinwala MM, Ye F, Sebastianski M, Abdulrahman A, Braam B, Jindal K, Khan M, Klarenbach S, Shojai S, Thompson S, Bello AK. The impact of community-based non-pharmacological interventions on cardiovascular and kidney disease outcomes in remote dwelling Indigenous communities: A scoping review protocol. PLoS One 2022; 17:e0269839. [PMID: 35687551 PMCID: PMC9187124 DOI: 10.1371/journal.pone.0269839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 05/27/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Indigenous people represent approximately 5% of the world’s population. However, they often have a disproportionately higher burden of cardiovascular disease (CVD) risk and chronic kidney disease (CKD) than their equivalent general population. Several non-pharmacological interventions (e.g., educational) have been used to reduce CVD and kidney disease risk factors in Indigenous groups. The aim of this paper is to describe the protocol for a scoping review that will assess the impact of non-pharmacological interventions carried out in Indigenous and remote dwelling populations to reduce CVD risk factors and CKD. Materials and methods This scoping review will be guided by the methodological framework for conducting scoping studies developed by Arksey and O’Malley. Both empirical (Medline, Embase, Cochrane Library, CINAHL, ISI Web of Science and PsycINFO) and grey literature references will be assessed if they focused on interventions targeted at reducing CVD or CKD among Indigenous groups. Two reviewers will independently screen references in consecutive stages of title/abstract screening and then full-text screening. Impact of interventions used will be assessed using the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework. A descriptive overview, tabular summaries, and content analysis will be carried out on the extracted data. Ethics and dissemination This review will collect and analyse evidence on the impact of interventions of research carried out to reduce CVD and CKD among Indigenous populations. Such evidence will be disseminated using traditional approaches that includes open-access peer-reviewed publication, scientific presentations, and a report. Also, we will disseminate our findings to the government and Indigenous leaders. Ethical approval will not be required for this scoping review as the data used will be extracted from already published studies with publicly accessible data.
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Affiliation(s)
- Ikechi G. Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Vinash Kumar Hariramani
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Naima Sultana
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Anukul Ghimire
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Deenaz Zaidi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Shezel Muneer
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Mohammed M. Tinwala
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Megan Sebastianski
- Knowledge Translation Platform, Alberta SPOR SUPPORT Unit Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Abdullah Abdulrahman
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Branko Braam
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kailash Jindal
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Khan
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Scott Klarenbach
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Soroush Shojai
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Stephanie Thompson
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
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6
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Harasemiw O, Komenda P, Tangri N. Addressing Inequities in Kidney Care for Indigenous People in Canada. J Am Soc Nephrol 2022; 33:1474-1476. [PMID: 35667707 PMCID: PMC9342645 DOI: 10.1681/asn.2022020215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Oksana Harasemiw
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada.,Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Komenda
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada.,Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Navdeep Tangri
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada .,Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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7
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Okpechi IG, Caskey FJ, Gaipov A, Tannor EK, Noubiap JJ, Effa E, Ekrikpo UE, Hamonic LN, Ashuntantang G, Bello AK, Donner JA, Figueiredo AE, Inagi R, Madero M, Malik C, Moorthy M, Pecoits-Filho R, Tesar V, Levin A, Jha V. Early Identification of Chronic Kidney Disease – A Scoping Review of the Global Populations. Kidney Int Rep 2022; 7:1341-1353. [PMID: 35685314 PMCID: PMC9171699 DOI: 10.1016/j.ekir.2022.03.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/18/2022] [Accepted: 03/28/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Decisions on whether to screen for chronic kidney disease (CKD) or not remain contentious in nephrology. This study provides a global overview of early CKD identification efforts. Methods Guidelines for scoping reviews were followed and studies were identified by searching MEDLINE, EMBASE, Cochrane Library, CINAHL, ISI Web of Science, and PsycINFO. Data extracted from included studies focused on the following 4 themes: study population, measurement methods, interventions used, and available policies. Results We identified 290 CKD screening and detection programs from 83 countries. Overall sample size was 3.72 million (North East Asia: 1.19 million), detection of CKD was the aim in 97.6%, 63.1% used population-based screening methods, and only 12.4% were in rural populations. Reported CKD prevalence (stages 3–5) was higher in targeted- (14.8%) than population-based studies (8.0%). Number of persons needed to screen (NNS) to identify 1 case was also lower in targeted studies (7 vs. 13). Single measurements (80%) and the combination of estimation of glomerular filtration rate with a urine test (albuminuria/proteinuria) (71.4%) were frequently used to detect CKD. Only 2.8% of studies included an intervention such as pharmacotherapy in identified cases. Policies on early identification were available in 30.1% of countries included. Conclusion Methods for early CKD identification vary worldwide, often leading to wide variations in the reported prevalence. Efforts to standardize measurement methods for early detection focusing on high-risk populations and ensuring appropriate interventions are available to those identified with CKD will improve the value of programs and improve patient outcomes.
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8
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Dart A. Sociodemographic determinants of chronic kidney disease in Indigenous children. Pediatr Nephrol 2022; 37:547-553. [PMID: 34032921 DOI: 10.1007/s00467-021-05110-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/07/2021] [Accepted: 04/28/2021] [Indexed: 11/28/2022]
Abstract
Rates of chronic kidney disease (CKD) are disproportionately increased in Indigenous peoples. The focus has traditionally been on adults, as they experience the highest rates of kidney failure requiring kidney replacement therapy. The impacts of colonization, systemic racism, and sociodemographic marginalization however impact the health of Indigenous peoples across the lifespan. This review presents the social context within which Indigenous children develop and the impact relevant to kidney health across the developmental stages. In utero exposures impact nephron endowment which can manifest in glomerular hyperfiltration and sclerosis as well as an increased risk of congenital anomalies of the kidney and urinary tract. Young children are at increased risk of autoimmune conditions, secondary to infectious and environmental exposures, and are also exposed to the impacts of a Western lifestyle manifesting early onset overweight/obesity. Adolescents begin to manifest more severe metabolic complications such as type 2 diabetes. The impacts of early onset diabetes are associated with aggressive kidney complications and high rates of kidney failure in young adulthood. Finally, the key elements of successful prevention and treatment strategies are discussed including the importance of screening for asymptomatic, modifiable early disease, linked with clinical primary and tertiary care follow-up, and culturally relevant and safe care.
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Affiliation(s)
- Allison Dart
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, Health Sciences Centre, University of Manitoba, CE-208 Children's Hospital, 840 Sherbrook St, Winnipeg, MV, R3A 1S1, Canada. .,Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.
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9
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Okpechi IG, Caskey FJ, Gaipov A, Tannor EK, Hamonic LN, Ashuntantang G, Donner JA, Figueiredo A, Inagi R, Madero M, Malik C, Moorthy M, Pecoits-Filho R, Tesar V, Levin A, Jha V. Assessing the impact of screening, early identification and intervention programmes for chronic kidney disease: protocol for a scoping review. BMJ Open 2021; 11:e053857. [PMID: 34916325 PMCID: PMC8679109 DOI: 10.1136/bmjopen-2021-053857] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) is a major threat to public health, especially in low-income and lower middle-income countries, where resources for treating patients with advanced CKD are scarce. Although early CKD identification and intervention hold promise for reducing the burden of CKD and risk factors, it remains unclear if an uniform strategy can be applicable across all income groups. The aim of this scoping review is to synthesise available evidence on early CKD identification programmes in all world regions and income groups. The study will also identify efforts that have been made to use interventions and implementation of early identification programmes for CKD across countries and income groups. METHODS AND ANALYSIS This review will be guided by the methodological framework for conducting scoping studies developed by Arksey and O'Malley. Empirical (Medline, Embase, Cochrane Library, CINAHL, ISI Web of Science and PsycINFO) and grey literature references will be searched to identify studies on CKD screening, early identification and interventions across all populations. Two reviewers will independently screen references in consecutive stages of title/abstract screening and then full-text screening. We will use a general descriptive overview, tabular summaries and content analysis on extracted data. ETHICS AND DISSEMINATION The findings from our planned scoping review will enable us to identify items in early identification programmes that can be used in developing screening toolkits for CKD. We will disseminate our findings using traditional approaches that include open-access peer-reviewed publication, scientific presentations and a white paper (call to action) report. Ethical approval will not be required for this scoping review as the data will be extracted from already published studies.
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Affiliation(s)
- Ikechi G Okpechi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Department of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Fergus J Caskey
- Richard Bright Renal Unit, North Bristol NHS Trust, Westbury on Trym, UK
- UK Renal Registry, Bristol, UK
| | | | - Elliot K Tannor
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Laura N Hamonic
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
| | - Gloria Ashuntantang
- Department of Internal Medicine and Subspecialties, University of Yaounde I, Yaounde, Cameroon
| | - Jo-Ann Donner
- Global Operations Centre, International Society of Nephrology, Brussels, Belgium
| | - Ana Figueiredo
- Nursing School, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Reiko Inagi
- Department of Medicine, The University of Tokyo Graduate School of Medicine, Bunkyo-ku, Japan
| | - Magdalena Madero
- Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Charu Malik
- Global Operations Centre, International Society of Nephrology, Brussels, Belgium
| | - Monica Moorthy
- Global Operations Centre, International Society of Nephrology, Brussels, Belgium
| | | | - Vladimir Tesar
- Department of Medicine, Charles University, Praha, Czech Republic
| | - Adeera Levin
- Department of Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Vivekanand Jha
- The George Institute for Global Health India, New Delhi, Delhi, India
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10
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Frejuk KL, Harasemiw O, Komenda P, Lavallee B, McLeod L, Chartrand C, Di Nella M, Ferguson TW, Martin H, Wicklow B, Dart AB. Impact of a screen, triage and treat program for identifying chronic disease risk in Indigenous children. CMAJ 2021; 193:E1415-E1422. [PMID: 34518342 PMCID: PMC8443280 DOI: 10.1503/cmaj.210507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis project was a point-of-care screening program in rural and remote First Nations communities in Manitoba that aimed to identify and treat hypertension, diabetes and chronic kidney disease. The program identified chronic disease in 20% of children screened. We aimed to characterize clinical screening practices before and after intervention in children aged 10-17 years old and compare outcomes with those who did not receive the intervention. METHODS This observational, prospective cohort study started with community engagement and followed the principles of ownership, control, access and possession (OCAP). We linked participant data to administrative data at the Manitoba Centre for Health Policy to assess rates of primary care and nephrology visits, disease-modifying medication prescriptions and laboratory testing (i.e., glycosylated hemoglobin [HbA1c], estimated glomerural filtration rate [eGFR] and urine albumin- or protein-to-creatinine ratio). We analyzed the differences in proportions in the 18 months before and after the intervention. We also conducted a 1:2 propensity score matching analysis to compare outcomes of children who were screened with those who were not. RESULTS We included 324 of 353 children from the screening program (43.8% male; median age 12.3 yr) in this study. After the intervention, laboratory testing increased by 5.8% (95% confidence interval [CI] 1.1% to 10.1%) for HbA1c, by 9.9% (95% CI 4.2% to 15.5%) for eGFR and by 6.2% (95% CI 2.3% to 10.0%) for the urine albumin- or protein-to-creatinine ratio. We observed significant improvements in laboratory testing in screened patients in the group who were part of the program, compared with matched controls. INTERPRETATION Chronic disease surveillance and care increased significantly in children after the implementation of a point-of-care screening program in rural and remote First Nation communities. Interventions such as active surveillance programs have the potential to improve the chronic disease care being provided to First Nations children.
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Affiliation(s)
- Kara L Frejuk
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Oksana Harasemiw
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Paul Komenda
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Barry Lavallee
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Lorraine McLeod
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Caroline Chartrand
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Michelle Di Nella
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Thomas W Ferguson
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Heather Martin
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Brandy Wicklow
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man
| | - Allison B Dart
- Max Rady College of Medicine (Frejuk), University of Manitoba; Chronic Disease Innovation Centre (Harasemiw, Komenda, Di Nella, Ferguson, Martin), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Komenda, Ferguson, Martin), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Wicklow, Dart); Children's Hospital Research Institute of Manitoba (Wicklow, Dart), Winnipeg, Man.
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Huria T, Pitama SG, Beckert L, Hughes J, Monk N, Lacey C, Palmer SC. Reported sources of health inequities in Indigenous Peoples with chronic kidney disease: a systematic review of quantitative studies. BMC Public Health 2021; 21:1447. [PMID: 34301234 PMCID: PMC8299576 DOI: 10.1186/s12889-021-11180-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 06/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To summarise the evidentiary basis related to causes of inequities in chronic kidney disease among Indigenous Peoples. METHODS We conducted a Kaupapa Māori meta-synthesis evaluating the epidemiology of chronic kidney diseases in Indigenous Peoples. Systematic searching of MEDLINE, Google Scholar, OVID Nursing, CENTRAL and Embase was conducted to 31 December 2019. Eligible studies were quantitative analyses (case series, case-control, cross-sectional or cohort study) including the following Indigenous Peoples: Māori, Aboriginal and Torres Strait Islander, Métis, First Nations Peoples of Canada, First Nations Peoples of the United States of America, Native Hawaiian and Indigenous Peoples of Taiwan. In the first cycle of coding, a descriptive synthesis of the study research aims, methods and outcomes was used to categorise findings inductively based on similarity in meaning using the David R Williams framework headings and subheadings. In the second cycle of analysis, the numbers of studies contributing to each category were summarised by frequency analysis. Completeness of reporting related to health research involving Indigenous Peoples was evaluated using the CONSIDER checklist. RESULTS Four thousand three hundred seventy-two unique study reports were screened and 180 studies proved eligible. The key finding was that epidemiological investigators most frequently reported biological processes of chronic kidney disease, particularly type 2 diabetes and cardiovascular disease as the principal causes of inequities in the burden of chronic kidney disease for colonised Indigenous Peoples. Social and basic causes of unequal health including the influences of economic, political and legal structures on chronic kidney disease burden were infrequently reported or absent in existing literature. CONCLUSIONS In this systematic review with meta-synthesis, a Kaupapa Māori methodology and the David R Williams framework was used to evaluate reported causes of health differences in chronic kidney disease in Indigenous Peoples. Current epidemiological practice is focussed on biological processes and surface causes of inequity, with limited reporting of the basic and social causes of disparities such as racism, economic and political/legal structures and socioeconomic status as sources of inequities.
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Affiliation(s)
- Tania Huria
- Māori Indigenous Health Institute, University of Otago Christchurch, 2 Riccarton Ave, Christchurch, 8140, New Zealand.
| | - Suzanne G Pitama
- Māori Indigenous Health Institute, University of Otago Christchurch, 2 Riccarton Ave, Christchurch, 8140, New Zealand
| | - Lutz Beckert
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | | | - Nathan Monk
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Cameron Lacey
- Māori Indigenous Health Institute, University of Otago Christchurch, 2 Riccarton Ave, Christchurch, 8140, New Zealand
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
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Harasemiw O, Ferguson T, Lavallee B, McLeod L, Chartrand C, Rigatto C, Tangri N, Dart A, Komenda P. Impact of point-of-care screening for hypertension, diabetes and progression of chronic kidney disease in rural Manitoba Indigenous communities. CMAJ 2021; 193:E1076-E1084. [PMID: 34281964 PMCID: PMC8315205 DOI: 10.1503/cmaj.201731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND: In 2013–2015, we conducted point-of-care screening for hypertension, diabetes and chronic kidney disease in rural and remote Indigenous communities in Manitoba, Canada. In this study, we aimed to determine whether optimal follow-up care was provided, defined as proportion of individuals with appropriate kidney disease laboratory testing, medication prescriptions and physician visits. METHODS: We linked screening data from participants to provincial administrative data sets to evaluate whether frequencies of laboratory testing, prescriptions of disease-modifying medications, and primary care and nephrology visits differed in the 18 months before and after screening. We also conducted a propensity score matching analysis to compare outcomes between screened and unscreened adults. RESULTS: Of 1353 adults who received the screening intervention and who had complete administrative data available, 44% were at risk of kidney failure at screening. Among these individuals, frequencies of comprehensive laboratory testing (estimated glomerular filtration rate and urine albumin to creatinine ratio) improved by 17.0% (95% confidence interval [CI] 11.5 to 22.5), anti-hyperglycemic medications improved by 4.4% (95% CI 1.0 to 7.8), and nephrology visits for participants meeting referral criteria improved by 5.9% (95% CI 3.4 to 8.5). We observed significant improvements in laboratory testing, antihyperglycemic medications and nephrology visits in the screened group compared with the 1:1 matched comparison group. INTERPRETATION: Point-of-care screening programs in rural and remote Indigenous communities are adaptable methods for increasing awareness, monitoring risk and treating chronic diseases. Interventions such as the development of a national screening program could improve chronic disease care in high-risk populations.
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Affiliation(s)
- Oksana Harasemiw
- Chronic Disease Innovation Centre (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Dart), University of Manitoba; Children's Hospital Research Institute of Manitoba (Dart), Winnipeg, Man
| | - Thomas Ferguson
- Chronic Disease Innovation Centre (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Dart), University of Manitoba; Children's Hospital Research Institute of Manitoba (Dart), Winnipeg, Man
| | - Barry Lavallee
- Chronic Disease Innovation Centre (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Dart), University of Manitoba; Children's Hospital Research Institute of Manitoba (Dart), Winnipeg, Man
| | - Lorraine McLeod
- Chronic Disease Innovation Centre (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Dart), University of Manitoba; Children's Hospital Research Institute of Manitoba (Dart), Winnipeg, Man
| | - Caroline Chartrand
- Chronic Disease Innovation Centre (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Dart), University of Manitoba; Children's Hospital Research Institute of Manitoba (Dart), Winnipeg, Man
| | - Claudio Rigatto
- Chronic Disease Innovation Centre (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Dart), University of Manitoba; Children's Hospital Research Institute of Manitoba (Dart), Winnipeg, Man
| | - Navdeep Tangri
- Chronic Disease Innovation Centre (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Dart), University of Manitoba; Children's Hospital Research Institute of Manitoba (Dart), Winnipeg, Man
| | - Allison Dart
- Chronic Disease Innovation Centre (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Dart), University of Manitoba; Children's Hospital Research Institute of Manitoba (Dart), Winnipeg, Man
| | - Paul Komenda
- Chronic Disease Innovation Centre (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), Seven Oaks General Hospital; Max Rady Department of Internal Medicine (Harasemiw, Ferguson, Rigatto, Tangri, Komenda), University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Lavallee, McLeod); Manitoba Keewatinowi Okimakanak Inc. (Lavallee, Chartrand); Department of Pediatrics and Child Health (Dart), University of Manitoba; Children's Hospital Research Institute of Manitoba (Dart), Winnipeg, Man.
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13
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Curtis S, Komenda P. Screening for chronic kidney disease: moving toward more sustainable health care. Curr Opin Nephrol Hypertens 2021; 29:333-338. [PMID: 32141896 DOI: 10.1097/mnh.0000000000000597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Chronic kidney disease (CKD) is a pervasive and growing health concern that has a significant impact on mortality and morbidity, putting stress on global healthcare systems. CKD affects ∼14% of general populations and ∼36% of high-risk populations and is projected to rise in the coming decade due to increasing rates of diabetes and hypertension. RECENT FINDINGS Screen, triage, and treat programs aim to detect early stage disease with the intention of promoting medical and lifestyle interventions in line with a patient's level of risk that may slow disease progression and reduce morbidity and mortality. Early detection facilitates appropriate risk stratification and coordination of care among patients, primary care and nephrology ensuring resources are utilized appropriately. SUMMARY By using readily available laboratory measures, screening for CKD in high-risk populations is cost effective and beneficial to both individuals and healthcare systems. Program models such as Kidney Early Evaluation Program and First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis have proven the efficacy of screening initiatives in these groups, but improvements are required to maximize the benefits of early CKD detection.
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Affiliation(s)
- Sarah Curtis
- Chronic Disease Innovation Centre, Seven Oaks Hospital Max Rady Department of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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14
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Kanpittaya J, Apipattarakul W, Chotmongkol V, Sawanyawisuth K. ADC cut points for chronic kidney disease in pathologically-proven cholangiocarcinoma. Eur J Radiol Open 2020; 8:100304. [PMID: 33335955 PMCID: PMC7734226 DOI: 10.1016/j.ejro.2020.100304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose Apparent diffusion coefficient (ADC) has been shown to indicate renal function in various conditions. As cholangiocarcinoma may have renal involvement due to immune complex-mediated glomerulonephritis, this study aimed to determine whether or not there is any association between ADC values and renal function in these patients. Methods This was a retrospective, analytical study. The inclusion criteria were age over 18 years, pathologically proven cholangiocarcinoma diagnosis and having undergone either 1.5 T or 3.0 T diffusion-weighted MRI. Chronic kidney disease (CKD) was defined as eGFR less than 60 mL/min/1.73m2. Patients’ ADC levels in the CKD and non-CKD groups were compared, and subgroup analysis was performed by MRI field strength and type of cholangiocarcinoma. Results One hundred fifty-eight patients participated in the study. Most were male (66.46 %), and the average age (SD) was 61.59 years (7.91). Average ADC levels in the CDK and non-CDK group differed significantly, regardless of MRI field strength or type of cholangiocarcinoma (2.11 mm/s2 in the ADC group vs 1.91 mm/s2 in the non-ADC group; P < 0.001). An ADC cut-point of 1.75 mm/s2 yielded sensitivities ranging from 66.67–90.00 in almost all study populations. The distal cholangiocarcinoma group had a perfect cut-point at 1.78 mm/s2 with 100 % sensitivity and area under the ROC curve. Conclusions Radiologists can use ADC to detect CKD in cholangiocarcinoma patients regardless of MRI field strength or type of cholangiocarcinoma.
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Affiliation(s)
| | | | - Verajit Chotmongkol
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kittisak Sawanyawisuth
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Corresponding author.
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Luyckx VA, Al-Aly Z, Bello AK, Bellorin-Font E, Carlini RG, Fabian J, Garcia-Garcia G, Iyengar A, Sekkarie M, van Biesen W, Ulasi I, Yeates K, Stanifer J. Sustainable Development Goals relevant to kidney health: an update on progress. Nat Rev Nephrol 2020; 17:15-32. [PMID: 33188362 PMCID: PMC7662029 DOI: 10.1038/s41581-020-00363-6] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 12/13/2022]
Abstract
Globally, more than 5 million people die annually from lack of access to critical treatments for kidney disease — by 2040, chronic kidney disease is projected to be the fifth leading cause of death worldwide. Kidney diseases are particularly challenging to tackle because they are pathologically diverse and are often asymptomatic. As such, kidney disease is often diagnosed late, and the global burden of kidney disease continues to be underappreciated. When kidney disease is not detected and treated early, patient care requires specialized resources that drive up cost, place many people at risk of catastrophic health expenditure and pose high opportunity costs for health systems. Prevention of kidney disease is highly cost-effective but requires a multisectoral holistic approach. Each Sustainable Development Goal (SDG) has the potential to impact kidney disease risk or improve early diagnosis and treatment, and thus reduce the need for high-cost care. All countries have agreed to strive to achieve the SDGs, but progress is disjointed and uneven among and within countries. The six SDG Transformations framework can be used to examine SDGs with relevance to kidney health that require attention and reveal inter-linkages among the SDGs that should accelerate progress. Working towards sustainable development is essential to tackle the rise in the global burden of non-communicable diseases, including kidney disease. Five years after the Sustainable Development Goal agenda was set, this Review examines the progress thus far, highlighting future challenges and opportunities, and explores the implications for kidney disease. Each Sustainable Development Goal (SDG) has the potential to improve kidney health and prevent kidney disease by improving the general health and well-being of individuals and societies, and by protecting the environment. Achievement of each SDG is interrelated to the achievement of multiple other SDGs; therefore, a multisectoral approach is required. The global burden of kidney disease has been relatively underestimated because of a lack of data. Structural violence and the social determinants of health have an important impact on kidney disease risk. Kidney disease is the leading global cause of catastrophic health expenditure, in part because of the high costs of kidney replacement therapy. Achievement of universal health coverage is the minimum requirement to ensure sustainable and affordable access to early detection and quality treatment of kidney disease and/or its risk factors, which should translate to a reduction in the burden of kidney failure in the future.
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Affiliation(s)
- Valerie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. .,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa. .,Institute of Biomedical Ethics and the History of Medicine, University of Zürich, Zürich, Switzerland.
| | - Ziyad Al-Aly
- Department of Medicine, Washington University in Saint Louis, Saint Louis, MO, USA.,Clinical Epidemiology Center, Veterans Affairs Saint Louis Health Care System, Saint Louis, MO, USA
| | - Aminu K Bello
- Division of Nephrology & Immunology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Raul G Carlini
- Sección de Investigación, Servicio de Nefrología y Trasplante Renal, Hospital Universitario de Caracas, Caracas, Venezuela
| | - June Fabian
- Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Witwatersrand, South Africa
| | - Guillermo Garcia-Garcia
- Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Hospital, 278, Guadalajara, Mexico
| | - Arpana Iyengar
- Department of Paediatric Nephrology, St. John's National Academy of Health Sciences, Bangalore, India
| | | | - Wim van Biesen
- Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Ifeoma Ulasi
- Renal Unit, Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Karen Yeates
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - John Stanifer
- Munson Nephrology, Munson Healthcare, Traverse City, MI, USA
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16
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Jaworsky D, Loutfy M, Lu M, Ye M, Bratu A, Sereda P, Bayoumi A, Richardson L, Kuper A, Hogg RS. Influence of the definition of rurality on geographic differences in HIV outcomes in British Columbia: a retrospective cohort analysis. CMAJ Open 2020; 8:E643-E650. [PMID: 33077535 PMCID: PMC7588262 DOI: 10.9778/cmajo.20200066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Improving rural health is often identified as a priority area for research and policy in Canada. We examined how findings on HIV outcomes (virologic suppression) can vary depending on the definition of rurality used. METHODS We performed retrospective cohort analyses using the Comparative Outcomes and Service Utilization Trends study population-based cohort of adults (age ≥ 19 yr) living with HIV in British Columbia between Apr. 1, 2012, and Mar. 31, 2013. We performed univariate logistic regression analyses using the following geographic variables to predict HIV virologic suppression: rurality defined by forward sortation area, by Statistical Area Classification and by health authority. We mapped suppression using geographic information systems. RESULTS Virologic suppression was observed in 5605 (65.2%) of 8598 participants. In univariate analysis, rurality defined by Statistical Area Classification (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.65-0.82), but not by forward sortation area, was associated with lower odds of suppression. When we examined suppression by health authority, Northern Health had the lowest odds of suppression (OR 0.46, 95% CI 0.36-0.58 compared to Vancouver Coastal Health). Geographic information systems mapping showed poorer suppression in northern areas. INTERPRETATION Health outcome findings can vary depending on the definition of the geographic variable. When including geographic variables, researchers should carefully consider variable definitions and whether other classification systems, such as north-south, are more appropriate than rurality for their analysis.
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Affiliation(s)
- Denise Jaworsky
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
| | - Mona Loutfy
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
| | - Michelle Lu
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
| | - Monica Ye
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
| | - Andreea Bratu
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
| | - Paul Sereda
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
| | - Ahmed Bayoumi
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
| | - Lisa Richardson
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
| | - Ayelet Kuper
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
| | - Robert S Hogg
- Faculty of Medicine (Jaworsky), University of British Columbia, Vancouver, BC; Institute for Health Policy, Management and Evaluation (Jaworsky, Loutfy, Bayoumi) and Department of Medicine (Loutfy, Bayoumi, Richardson, Kuper), University of Toronto, Toronto, Ont.; Northern Medical Program (Jaworsky), University of Northern British Columbia, Prince George, BC; BC Centre for Excellence in HIV/AIDS (Jaworsky, Lu, Ye, Bratu, Sereda, Hogg), Vancouver, BC; Department of Medicine (Loutfy, Richardson), Women's College Hospital; Division of General Internal Medicine (Bayoumi) and MAP Centre for Urban Health Solutions (Bayoumi), Li Ka Shing Knowledge Institute, St. Michael's Hospital; University Health Network (Richardson); The Wilson Centre (Richardson, Kuper); Toronto, Ont.; Faculty of Health Sciences (Hogg), Simon Fraser University, Burnaby, BC
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Mabilangan C, Burton C, O’Brien S, Plitt S, Eurich D, Preiksaitis J. Using blood donors and solid organ transplant donors and recipients to estimate the seroprevalence of cytomegalovirus and Epstein-Barr virus in Canada: A cross-sectional study. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2020; 5:158-176. [PMID: 36341316 PMCID: PMC9608736 DOI: 10.3138/jammi-2020-0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/03/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infections are common, causing significant morbidity in pregnancy (congenital CMV) and transplant recipients (CMV, EBV). Canadian prevalence data are needed to model disease burden and develop strategies for future vaccines. We estimated prevalence using screening data from blood donors and solid organ transplant (SOT) donors and recipients. METHODS We retrospectively analyzed CMV and EBV serology from Alberta SOT donors (n = 3,016) and recipients (n = 4,614) (1984-2013) and Canadian Blood Services blood donors (n = 1,253,350) (2005-2014), studying associations with age, sex, organ, year, and geographic region. RESULTS CMV seroprevalence rises gradually with age. By age 70, CMV seropositivity ranged from 67% (blood donors) to 73% (SOT recipients). Significant proportions of women of child-bearing age were CMV-seronegative (organ donors, 44%; SOT recipients, 43%; blood donors, 61%). Blood donor CMV seroprevalence decreased from 48% in Western Canada to 30% in Eastern Canada. Women were more likely to be CMV-seropositive (ORs = 1.58, 1.45, and 1.11 for organ donors, SOT recipients, and blood donors, respectively) and EBV-seropositive (ORs = 1.87 and 1.46 for organ donors and SOT recipients, respectively). EBV prevalence rises rapidly, and by age 17-29 years, 81% of SOT recipients and 90% of organ donors were seropositive. CONCLUSIONS Canada has relatively low and perhaps decreasing age-specific EBV and CMV prevalence, making Canadians vulnerable to primary infection-associated morbidity and suggesting benefit from future vaccines. Collection and analysis of routine serology screening data are useful for observing trends.
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Affiliation(s)
- Curtis Mabilangan
- Division of Infectious Diseases, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine Burton
- Division of Infectious Diseases, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Sheila O’Brien
- Canadian Blood Services, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sabrina Plitt
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Dean Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jutta Preiksaitis
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Correspondence: Jutta Preiksaitis, Division of Infectious Diseases, Department of Medicine, 1-125 CSB, 11350 83 Avenue, Edmonton, Alberta T6G 2G3, Canada. Telephone: 780-492-8164. Fax: 780-492-8050. E-mail:
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Erdmann R, Morrin L, Harvey R, Joya L, Clifford A, Soroka S. Canadian Senior Renal Leaders Community of Practice: Vulnerable Populations With Chronic Kidney Disease-Evidence to Inform Policy. Can J Kidney Health Dis 2020; 7:2054358120930977. [PMID: 32782812 PMCID: PMC7383632 DOI: 10.1177/2054358120930977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/14/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose: Low socioeconomic status, race, ethnicity, and rural/remote populations are all associated with disparities in access, care, and outcomes for chronic kidney disease (CKD). There have been different interventions supported by Canadian renal programs to address these disparities. This article reviews the evidence for impact of strategies to reduce inequities experienced by vulnerable populations living with or at risk of CKD and to collate and share interprovincial targeted interventions through the newly formed “Canadian Senior Renal Leaders Community of Practice” focused on translating evidence into clinical practice and policy. Source of Information: A literature search of Medline, CINAHL, PubMed, and Google Scholar from 2008 to 2018 identified 13 reports of processes and interventions that have been implemented in Australia, Canada, and the United States to reduce inequities in CKD care and can be categorized into 3 broad areas: (1) early screening and prevention, (2) disease management and dialysis, and (3) pretransplant. Web sites from each Canadian jurisdiction and from Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD) Network were used to assess the current state of Canadian initiatives. Methods: Reviews were completed to gather information on renal initiatives for vulnerable populations, including (1) identification of populations that experience disparities in access to care or in outcomes in the context of CKD prevention and treatment and (2) interventions that have been implemented to reduce disparities in access, care, and outcomes for vulnerable populations with CKD. A current state summary of Canadian initiatives related to vulnerable populations was conducted through a review of publicly available information, including a review of renal program Web sites and a review of current projects related to vulnerable populations that are part of Can-SOLVE CKD. Can-SOLVE CKD is a Canadian Institutes of Health Research Strategy for Patient-Oriented Research (CIHR-SPOR) funded research network to transform the care of people affected by kidney disease. Key Findings: Interventions to improve inequities in access to CKD screening, disease management, and care are successful when developed with community engagement, provided to the patient in their own environment, and tailored to specific populations. Many provincial renal programs have implemented initiatives to support vulnerable populations with or at risk of CKD. Current projects funded through CIHR SPOR focus on underserved populations and involve partnerships with Indigenous populations. Many renal programs in Canada had or were in the process of implementing interventions to support vulnerable populations with CKD; however, information about the initiatives were not readily available online despite a strong interest and opportunity to support interprovincial knowledge sharing. Despite this common interest, little information is systematically shared between Canadian jurisdictions to support interprovincial sharing to promote evidence-informed policy and program development. Efforts will be made through the newly formed Canadian Senior Renal Leaders Community of Practice to collaborate and share learnings to inform future program and policy development, implementation, and evaluation. Limitations: As this was not a systematic review, literature search only encompassed studies published in English between 2008 and 2018. It is possible that populations and interventions were overlooked during the search and through the screening process. Furthermore, the controversial definition of “vulnerable” and literature that only came from Canada, the United States, and Australia limits the generalizability of this review.
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Affiliation(s)
| | | | | | - Lisa Joya
- Cancer Care Ontario, Toronto, Canada
| | | | - Steven Soroka
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, Canada
- Steven Soroka, Nova Scotia Health Authority, 5880 Dickson Building, 5820 University Ave, Halifax, NS, Canada B3H 1V8.
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Pylypjuk C, Sellers E, Wicklow B. Perinatal Outcomes in a Longitudinal Birth Cohort of First Nations Mothers With Pregestational Type 2 Diabetes and Their Offspring: The Next Generation Study. Can J Diabetes 2020; 45:27-32. [PMID: 32800764 DOI: 10.1016/j.jcjd.2020.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/17/2020] [Accepted: 05/04/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVES There is emerging evidence that First Nations women with diabetes in pregnancy and their offspring have poorer health outcomes than non-First Nations women. The aim of this study was to describe the perinatal outcomes of pregnancies complicated by type 2 diabetes. METHODS The Next Generation longitudinal study is a First Nations birth cohort of children born to mothers diagnosed in childhood with type 2 diabetes. Pregnant women were prospectively enrolled in the birth cohort, and a review of medical records (including stored fetal ultrasound images) was performed to determine perinatal outcomes for 112 child-mother pairs between 2005 and 2015. Maternal demographics, antenatal variables, fetal ultrasound findings, obstetric and delivery information and neonatal birth outcomes were collected and analyzed. RESULTS Mothers in our cohort were young and most were overweight at the start of pregnancy. Most had suboptimal glycemic control in the first trimester (median glycated hemoglobin, 9.3%). The cesarean section rate was high at 41%. Over one-half of newborns had macrosomia at birth, and almost 1 in 5 were born with a structural anomaly, mainly renal. Fetal ultrasound significantly underestimated the proportion of infants born with macrosomia (p<0.05) and missed 3 of 7 cardiac defects in this cohort. CONCLUSIONS High rates of anomalies, macrosomia and cesarean deliveries provide insight into pregnancy management and disease processes for First Nations women with pregestational type 2 diabetes and their offspring, and highlights opportunities for improvement in prenatal care of these women.
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Affiliation(s)
- Christy Pylypjuk
- Department of Obstetrics, Gynecology and Reproductive Sciences (Section of Maternal-Fetal Medicine), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; The Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth Sellers
- The Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health (Section of Endocrinology and Metabolism), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brandy Wicklow
- The Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health (Section of Endocrinology and Metabolism), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
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Ovtcharenko N, Thomson BKA. Interventions to Improve Clinical Outcomes in Indigenous or Remote Patients With Chronic Kidney Disease: A Scoping Review. Can J Kidney Health Dis 2019; 6:2054358119887154. [PMID: 31798926 PMCID: PMC6859680 DOI: 10.1177/2054358119887154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 09/24/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Chronic kidney disease (CKD) associates with a significant health care burden with a disproportionate impact on indigenous persons or people living in remote areas. Although screening programs have expanded in these communities, there remains a paucity of evidence-based interventions to enhance clinical renal outcomes in these populations. Objective: The objective of this study was to identify evidence-based interventions to enhance renal outcomes in these populations. Design: A scoping review was conducted for studies in the Cochrane, MEDLINE, and Embase databases and from major nephrology meetings. Setting: Chronic kidney disease, including those on dialysis. Patients: Remote or indigenous populations Measurements: Studies that performed an intervention that was followed by measurement of renal outcomes or patient-centered outcomes (ie, quality of life) were included. Methods: All studies were described by study type, intervention, and clinical outcome, and trends were identified by both authors. Meta-analysis was not conducted due to study heterogeneity. Results: Thirty-two studies met inclusion criteria, only 2 (6.3%) of which were randomized controlled trials. Intervention types included multidisciplinary (34.4%), satellite (32.3%), telehealth (25.0%), or other (9.4%). All multidisciplinary interventions were performed in the CKD (non-dialysis) setting and reported improved patient travel time, waiting time, quality of life, kidney function, proteinuria, and blood pressure. Telehealth interventions improved program cost, patient attendance, hospitalization, and quality of life. Satellite interventions were performed in the hemodialysis setting, with 1 study evaluating acute hemodialysis. Satellite interventions improved patient travel time, dialysis clearance, quality of life, and survival, but increased program costs. Limitations: The study was restricted to interventional trials assessing clinical outcomes and to studies in developed countries, which likely excluded some research contributing to this field. Conclusions: There is significant heterogeneity among studies of interventions for patients with CKD who are indigenous or live remotely. Interventions were more likely to be successful when the remote or indigenous community was included in program development, with a culturally safe approach. More large, high-quality studies are needed to identify effective interventions to enhance clinical renal outcomes in indigenous or remote populations. Trial Registration: This trial is registered under PROSPERO, Registration Number 128453.
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Affiliation(s)
- N Ovtcharenko
- Division of Internal Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - B K A Thomson
- Division of Internal Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada.,Division of Nephrology, Department of Medicine, Queen's University, Kingston, ON, Canada
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Canney M, Induruwage D, McCandless LC, Reich HN, Barbour SJ. Disease-specific incident glomerulonephritis displays geographic clustering in under-serviced rural areas of British Columbia, Canada. Kidney Int 2019; 96:421-428. [DOI: 10.1016/j.kint.2019.02.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/07/2019] [Accepted: 02/14/2019] [Indexed: 12/12/2022]
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Kelly L, Matsumoto CL, Schreiber Y, Gordon J, Willms H, Olivier C, Madden S, Hopko J, Tobe SW. Prevalence of chronic kidney disease and cardiovascular comorbidities in adults in First Nations communities in northwest Ontario: a retrospective observational study. CMAJ Open 2019; 7:E568-E572. [PMID: 31501170 PMCID: PMC6768774 DOI: 10.9778/cmajo.20190040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The prevalence of adult chronic kidney disease and cardiovascular comorbidities in Canadian Indigenous communities is largely unknown. We conducted a study to document the prevalence of chronic kidney disease and concurrent diabetes mellitus, hypertension and dyslipidemia in a First Nations population in northwest Ontario. METHODS In this observational study, we used retrospective data collected from regional electronic medical records of 16 170 adults (age ≥ 18 yr) from 26 First Nations communities in northwest Ontario from May 2014 to May 2017. Demographic and laboratory data included age, gender, prescribed medications, estimated glomerular filtration rate, urine albumin:creatinine ratio, low-density lipoprotein cholesterol (LDL-C) level and glycated hemoglobin (HbA1c) concentration. We identified patients with diabetes by an HbA1c concentration of 6.5% or higher, or the use of a diabetic medication, those with dyslipidemia by an elevated LDL-C level (≥ 2.0 mmol/L) or use of lipid-lowering medication, and those with hypertension by use of antihypertensive medication. RESULTS Of the 16 170 adults residing in the communities, 5224 unique patients (32.3%) had renal testing (albumin:creatinine ratio and/or estimated glomerular filtration rate). The age-adjusted prevalence of chronic kidney disease was 14.5%, and the prevalence of stage 3-5 chronic kidney disease (estimated glomerular filtration rate < 60 mL/min) was 7.0%. Most patients with chronic kidney disease (1487 [80.0%]) had at least 1 cardiovascular comorbidity. A total of 1332 patients (71.6%) had diabetes, 1313 (70.6%) had dyslipidemia, and 1098 (59.1%) had hypertension; all 3 comorbidities were present in 716 patients (38.5%). INTERPRETATION We document a high prevalence of advanced chronic kidney disease in this First Nations population, 7.0%, double the rate in the general population. High rates of cardiovascular comorbidities were also common in these patients with chronic kidney disease, which places them at increased risk for cardiovascular disease.
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Affiliation(s)
- Len Kelly
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont.
| | - Cai-Lei Matsumoto
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Yoko Schreiber
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Janet Gordon
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Hannah Willms
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Christopher Olivier
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Sharen Madden
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Josh Hopko
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Sheldon W Tobe
- Anishinaabe Bimaadiziwin Research Program (Kelly, Schreiber, Willms), Sioux Lookout Meno Ya Win Health Centre; Approaches to Community Wellbeing (Matsumoto) and Health Services (Gordon, Hopko), Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.; Division of Infectious Diseases (Schreiber), The Ottawa Hospital, University of Ottawa; The Ottawa Hospital Research Institute (Schreiber); School of Epidemiology and Public Health (Schreiber), University of Ottawa, Ottawa, Ont.; University of Saskatchewan (Olivier), Saskatoon, Sask.; Division of Clinical Sciences (Madden), Northern Ontario School of Medicine, Sioux Lookout, Ont.; Department of Medicine (Tobe), Sunnybrook Health Sciences Centre, Toronto, Ont
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Transplant center assessment of the inequity in the kidney transplant process and outcomes for the Indigenous American patients. PLoS One 2018; 13:e0207819. [PMID: 30462724 PMCID: PMC6249016 DOI: 10.1371/journal.pone.0207819] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/06/2018] [Indexed: 12/18/2022] Open
Abstract
Background The goal is to determine the delays and reduced rates of kidney transplant (KTx) for the Indigenous Americans and variables predictive of these outcomes at a large single transplant center. Methods 300 Indigenous Americans and 300 non-Hispanic white American patients presenting for KTx evaluation from 2012–2016 were studied. Results Compared to whites, the Indigenous Americans had the following: more diabetes, dialysis, physical limitation and worse socioeconomic characteristics(p<0.01); median difference of 20 day delay from referral to KTx evaluation, 17 day delay from approval to UNOS listing and 126.5 longer delay on the waitlist compared to whites(p<0.001). Of the Indigenous Americans listed, more died, were removed, or were still waiting than transplanted compared to whites (p<0.001). Variables predictive of delay from referral to transplant evaluation included: Indigenous race, distance from transplant center, coronary artery disease, and time on dialysis (p<0.05). Cumulative incidence of waitlisting and KTx was lower for Indigenous Americans (p<0.0001). Independent predictors of decreased likelihood of waitlisting included age, peripheral vascular disease, no caregiver, physical limitation, and illegal drug use history (p<0.05). Variables predictive of lower likelihood of KTx included Indigenous race, percentage of time inactive on the waitlist, no caregiver, and O blood type. Conclusions Among patients referred and evaluated for KTx, the Indigenous American race was independently associated with significant delays in the KTx process after accounting for co-morbid and socioeconomic factors. Cardiovascular morbidity and physical limitation were identified as important determinants of delay and decreased likelihood of waitlisting. Further quantitative and qualitative work is needed to identify and intervene on modifiable barriers to improve access to KTx for the Indigenous Americans.
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Thomas DA, Huang A, McCarron MCE, Kappel JE, Holden RM, Yeates KE, Richardson BR. A Retrospective Study of Chronic Kidney Disease Burden in Saskatchewan's First Nations People. Can J Kidney Health Dis 2018; 5:2054358118799689. [PMID: 30245841 PMCID: PMC6144512 DOI: 10.1177/2054358118799689] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 07/12/2018] [Indexed: 12/26/2022] Open
Abstract
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 communities.
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Affiliation(s)
- Dorothy A Thomas
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Anne Huang
- First Nations and Inuit Health, Health Canada, Saskatoon, SK, Canada
| | | | - Joanne E Kappel
- Division of Nephrology, Department of Medicine, Saskatchewan Health Authority, Saskatoon, Canada
| | - Rachel M Holden
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Karen E Yeates
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Bonnie R Richardson
- Section of Nephrology, Department of Medicine, Saskatchewan Health Authority, Regina, Canada
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Ma I, Guo M, Muruve D, Benediktsson H, Naugler C. Sociodemographic associations with abnormal estimated glomerular filtration rate (eGFR) in a large Canadian city: a cross-sectional observation study. BMC Nephrol 2018; 19:198. [PMID: 30092764 PMCID: PMC6085713 DOI: 10.1186/s12882-018-0991-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 07/23/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is often asymptomatic in its early stages but is indicated and is diagnosed with an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2. Certain sociodemographic groups are known to be at risk for CKD, but it is unclear if there are strong associations between these at risk groups with abnormal eGFR test results in Canada. Using only secondary laboratory and Census data, geospatial variation and sociodemographic associations with abnormal eGFR result rate were investigated in Calgary, Alberta. METHODS Secondary laboratory data from all adult community patients who received an eGFR test result were collected from Calgary Laboratory Service's Laboratory Information System, which is the sole supplier of laboratory services for the large metropolitan city. Group-level sociodemographic variables were inferred by combining laboratory data with the 2011 Canadian Census data. Poisson regression and relative risk (RR) were used to calculate associations between sociodemographic variables with abnormal eGFR. Geographical distribution of abnormal eGFR result rates were analyzed by geospatial analysis using ArcGIS. RESULTS Of the 346,663 adult community patients who received an eGFR test result, 28,091 were abnormal (8.1%; eGFR < 60 ml/min/1.73m2). Geospatial analysis revealed distinct geographical variation in abnormal eGFR result rates in Calgary. Women (RR = 1.11, P < 0.0001), and the elderly (age ≥ 70 years; P < 0.0001) were significantly associated with an increased risk for CKD, while visible minority Chinese (RR = 0.73, P = 0.0011), South Asians (RR = 0.67, P < 0.0001) and those with a high median household income (RR = 0.88, P < 0.0001) had a significantly reduced risk for CKD. CONCLUSIONS Presented here are significant sociodemographic risk associations, and geospatial clustering of abnormal eGFR result rates in a large metropolitan Canadian city. Using solely publically available secondary laboratory and Census data, the results from this study aligns with known sociodemographic risk factors for CKD, as certain sociodemographic variables were at a higher risk for having an abnormal eGFR test result, while others were protective in this analysis.
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Affiliation(s)
- Irene Ma
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, 9, 3535 Research Rd NW, Calgary, AB, T2L 2K8, Canada
| | - Maggie Guo
- Calgary Laboratory Services, Calgary, AB, Canada
| | - Daniel Muruve
- Department of Medicine, Cumming School of Medicine, University of Calgary, 9, 3535 Research Rd NW, Calgary, AB, T2L 2K8, Canada
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, 9, 3535 Research Rd NW, Calgary, AB, T2L 2K8, Canada
| | - Hallgrimur Benediktsson
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, 9, 3535 Research Rd NW, Calgary, AB, T2L 2K8, Canada
- Calgary Laboratory Services, Calgary, AB, Canada
| | - Christopher Naugler
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, 9, 3535 Research Rd NW, Calgary, AB, T2L 2K8, Canada.
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, 9, 3535 Research Rd NW, Calgary, AB, T2L 2K8, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 9, 3535 Research Rd NW, Calgary, AB, T2L 2K8, Canada.
- Calgary Laboratory Services, Calgary, AB, Canada.
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Kyoon-Achan G, Lavoie J, Avery Kinew K, Phillips-Beck W, Ibrahim N, Sinclair S, Katz A. Innovating for Transformation in First Nations Health Using Community-Based Participatory Research. QUALITATIVE HEALTH RESEARCH 2018; 28:1036-1049. [PMID: 29484964 DOI: 10.1177/1049732318756056] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Community-based participatory research (CBPR) provides the opportunity to engage communities for sustainable change. We share a journey to transformation in our work with eight Manitoba First Nations seeking to improve the health of their communities and discuss lessons learned. The study used community-based participatory research approach for the conceptualization of the study, data collection, analysis, and knowledge translation. It was accomplished through a variety of methods, including qualitative interviews, administrative health data analyses, surveys, and case studies. Research relationships built on strong ethics and protocols to enhance mutual commitment to support community-driven transformation. Collaborative and respectful relationships are platforms for defining and strengthening community health care priorities. We further discuss how partnerships were forged to own and sustain innovations. This article contributes a blueprint for respectful CBPR. The outcome is a community-owned, widely recognized process that is sustainable while fulfilling researcher and funding obligations.
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Affiliation(s)
- Grace Kyoon-Achan
- 1 University of Manitoba, Winnipeg, Manitoba, Canada
- 2 Nanaandawewiwgamig-First Nations Health and Social Secretariat of Manitoba, Winnipeg, Manitoba, Canada
| | - Josée Lavoie
- 1 University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kathi Avery Kinew
- 1 University of Manitoba, Winnipeg, Manitoba, Canada
- 2 Nanaandawewiwgamig-First Nations Health and Social Secretariat of Manitoba, Winnipeg, Manitoba, Canada
| | - Wanda Phillips-Beck
- 1 University of Manitoba, Winnipeg, Manitoba, Canada
- 2 Nanaandawewiwgamig-First Nations Health and Social Secretariat of Manitoba, Winnipeg, Manitoba, Canada
| | - Naser Ibrahim
- 1 University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stephanie Sinclair
- 2 Nanaandawewiwgamig-First Nations Health and Social Secretariat of Manitoba, Winnipeg, Manitoba, Canada
| | - Alan Katz
- 1 University of Manitoba, Winnipeg, Manitoba, Canada
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Collister D, Tangri N. Conventional Risk Factors Associated With Meaningful Outcomes in Advanced CKD. Kidney Int Rep 2018; 3:513-515. [PMID: 29854958 PMCID: PMC5976847 DOI: 10.1016/j.ekir.2018.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- David Collister
- Division of Nephrology, McMaster University, Hamilton, Ontario, Canada
| | - Navdeep Tangri
- Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Dart A, Lavallee B, Chartrand C, McLeod L, Ferguson TW, Tangri N, Gordon A, Blydt-Hansen T, Rigatto C, Komenda P. Screening for kidney disease in Indigenous Canadian children: The FINISHED screen, triage and treat program. Paediatr Child Health 2018; 23:e134-e142. [PMID: 30374222 DOI: 10.1093/pch/pxy013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Indigenous populations are disproportionately affected by kidney failure at younger ages than other ethnic groups in Canada. As symptoms do not occur until disease is advanced, early kidney disease risk is often unrecognized. Objectives We sought to evaluate the yield of community-based screening for early risk factors for kidney disease in youth from rural Indigenous communities in Canada. Methods The FINISHED project screened 11 rural First Nations communities in Manitoba, Canada after community and school engagement. The results for the 10- to 17-year olds are reported here. Body mass index (BMI), blood pressure, estimated glomerular filtration rate (eGFR), hemoglobin A1c's (HbA1c) and urine albumin-to-creatinine ratios (ACR) were assessed. All children were triaged and referred to either primary or tertiary care, depending on risk. Results A total of 353 were screened (estimated 22.4% of population). The median age was 12 years (IQR 10 to 13), 55% were female and 55% were overweight or obese. Overall, 21.8% of children had at least one abnormality. Hypertension was identified in 5.4% and 11.9% had prehypertension. None of the children had an eGFR < 60 ml/min/1.73 m2 however 10.5% had an ACR > 3 mg/mmol and 6.2% had an eGFR < 90 ml/min/1.73 m2 suggestive of early kidney disease. Diabetes was identified in 1.4%, and 1.4% had HbA1c's between 6.1% and 6.49%. Conclusions Risk factors for chronic kidney disease are highly prevalent in rural Indigenous children. More research is required to confirm the persistence of these findings, and to evaluate the efficacy of screening children to prevent or delay progression to kidney failure.
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Affiliation(s)
- Allison Dart
- Department of Pediatrics and Child Health, University of Manitoba and Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Barry Lavallee
- Centre for Aboriginal Health Education, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | - Thomas W Ferguson
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Navdeep Tangri
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Audrey Gordon
- Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Tom Blydt-Hansen
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Claudio Rigatto
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Komenda
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Crowshoe L, Dannenbaum D, Green M, Henderson R, Hayward MN, Toth E. Type 2 Diabetes and Indigenous Peoples. Can J Diabetes 2018; 42 Suppl 1:S296-S306. [DOI: 10.1016/j.jcjd.2017.10.022] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Indexed: 12/16/2022]
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Remote Dwelling Location Is a Risk Factor for CKD Among Indigenous Canadians. Kidney Int Rep 2018; 3:825-832. [PMID: 29989009 PMCID: PMC6035135 DOI: 10.1016/j.ekir.2018.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/23/2018] [Accepted: 02/05/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction Rural and remote indigenous individuals have a high burden of chronic kidney disease (CKD) when compared to the general population. However, it has not been previously explored how these rates compare to urban-dwelling indigenous populations. Methods In a recent cross-sectional screening study, 1346 adults 18 to 80 years of age were screened for CKD and diabetes across 11 communities in rural and remote areas in Manitoba, Canada, as part of the First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis (FINISHED) program. An additional 284 Indigenous adults who resided in low-income areas in the city of Winnipeg, Manitoba, Canada were screened as part of the NorWest Mobile Diabetes and Kidney Disease Screening and Intervention Project. Results Our findings indicate that a gradient of CKD and diabetes prevalence exists for Indigenous individuals living in different geographic areas. Compared to urban-dwelling Indigenous individuals, rural-dwelling individuals had more than a 2-fold (2.1, 95% CI = 1.4-3.1) increase in diabetes whereas remote-dwelling individuals had a 4-fold (4.1, 95% CI = 2.8-6.0) increase, and more than a 3-fold (3.1, 95% CI = 2.2-4.5) increase in CKD prevalence. Conclusion Although these results highlight the relative importance of geography in determining the prevalence of diabetes and CKD in Indigenous Canadians, geography is but an important surrogate of other determinants, such as poverty and access to care.
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Abstract
Chronic kidney disease (CKD) is defined by persistent urine abnormalities, structural abnormalities or impaired excretory renal function suggestive of a loss of functional nephrons. The majority of patients with CKD are at risk of accelerated cardiovascular disease and death. For those who progress to end-stage renal disease, the limited accessibility to renal replacement therapy is a problem in many parts of the world. Risk factors for the development and progression of CKD include low nephron number at birth, nephron loss due to increasing age and acute or chronic kidney injuries caused by toxic exposures or diseases (for example, obesity and type 2 diabetes mellitus). The management of patients with CKD is focused on early detection or prevention, treatment of the underlying cause (if possible) to curb progression and attention to secondary processes that contribute to ongoing nephron loss. Blood pressure control, inhibition of the renin-angiotensin system and disease-specific interventions are the cornerstones of therapy. CKD complications such as anaemia, metabolic acidosis and secondary hyperparathyroidism affect cardiovascular health and quality of life, and require diagnosis and treatment.
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Whitlock RH, Chartier M, Komenda P, Hingwala J, Rigatto C, Walld R, Dart A, Tangri N. Validation of the Kidney Failure Risk Equation in Manitoba. Can J Kidney Health Dis 2017; 4:2054358117705372. [PMID: 28491341 PMCID: PMC5406122 DOI: 10.1177/2054358117705372] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 12/20/2017] [Indexed: 01/04/2023] Open
Abstract
Background: Patients with chronic kidney disease (CKD) are at risk to progress to kidney failure. We previously developed the Kidney Failure Risk Equation (KFRE) to predict progression to kidney failure in patients referred to nephrologists. Objective: The objective of this study was to determine the ability of the KFRE to discriminate which patients will progress to kidney failure in an unreferred population. Design: A retrospective cohort study was conducted using administrative databases. Setting: This study took place in Manitoba, Canada. Measurements: Age, sex, estimated glomerular filtration rate (eGFR), and urine albumin-to-creatinine ratio (ACR) were measured. Methods: We included patients from the Diagnostic Services of Manitoba database with an eGFR <60 mL/min/1.73 m2 and ACR measured between October 2006 and March 2007. Five-year kidney failure risk was predicted using the 4-variable KFRE and compared with treated kidney failure events from the Manitoba Renal Program database. Sensitivity and specificity for KFRE risk thresholds (3% and 10% over 5 years) were compared with eGFR thresholds (30 and 45 mL/min/1.73 m2). Results: Of 1512 included patients, 151 developed kidney failure over the 5-year follow-up period. The 4-variable KFRE showed a superior prognostic discrimination compared with eGFR alone (area under the receiver operating characteristic curve [AUROC] values, 0.90 [95% confidence interval {CI}: 0.88-0.92] for KFRE vs 0.78 [95% CI: 0.74-0.83] for eGFR). At a 3% threshold over 5 years, the KFRE had a sensitivity of 97% and a specificity of 62%. At 10% risk, sensitivity was 86%, and specificity was 80%. Limitations: Only 11.7% of stage 3-5 CKD patients had simultaneous ACR measurement. The KFRE does not account for other indications for referral such as suspected glomerulonephritis, polycystic kidney disease, and recurrent stone disease. Conclusions: The KFRE has been validated in a population with a demographic and referral profile heretofore untested and performs well at predicting 5-year risk of kidney failure in a population-based sample of Manitobans with CKD stages 3 to 5. Thresholds of 3% and 10% over 5 years are sensitive, specific, and can be used in clinical decision making. Further testing of the 4-variable KFRE and these thresholds in clinical practice should be considered.
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Affiliation(s)
- Reid H Whitlock
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
| | - Mariette Chartier
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Paul Komenda
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada.,Section of Nephrology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Jay Hingwala
- Section of Nephrology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Claudio Rigatto
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada.,Section of Nephrology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Randy Walld
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Allison Dart
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Navdeep Tangri
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada.,Section of Nephrology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Screening for chronic kidney disease in Canadian indigenous peoples is cost-effective. Kidney Int 2017; 92:192-200. [PMID: 28433383 DOI: 10.1016/j.kint.2017.02.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/23/2017] [Accepted: 02/02/2017] [Indexed: 01/02/2023]
Abstract
Canadian indigenous (First Nations) have rates of kidney failure that are 2- to 4-fold higher than the non-indigenous general Canadian population. As such, a strategy of targeted screening and treatment for CKD may be cost-effective in this population. Our objective was to assess the cost utility of screening and subsequent treatment for CKD in rural Canadian indigenous adults by both estimated glomerular filtration rate and the urine albumin-to-creatinine ratio. A decision analytic Markov model was constructed comparing the screening and treatment strategy to usual care. Primary outcomes were presented as incremental cost-effectiveness ratios (ICERs) presented as a cost per quality-adjusted life-year (QALY). Screening for CKD was associated with an ICER of $23,700/QALY in comparison to usual care. Restricting the model to screening in communities accessed only by air travel (CKD prevalence 34.4%), this ratio fell to $7,790/QALY. In road accessible communities (CKD prevalence 17.6%) the ICER was $52,480/QALY. The model was robust to changes in influential variables when tested in univariate sensitivity analyses. Probabilistic sensitivity analysis found 72% of simulations to be cost-effective at a $50,000/QALY threshold and 93% of simulations to be cost-effective at a $100,000/QALY threshold. Thus, targeted screening and treatment for CKD using point-of-care testing equipment in rural Canadian indigenous populations is cost-effective, particularly in remote air access-only communities with the highest risk of CKD and kidney failure. Evaluation of targeted screening initiatives with cluster randomized controlled trials and integration of screening into routine clinical visits in communities with the highest risk is recommended.
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