Presentation for Health Care Staff & Health Stakeholders Diabetes, Blood Pressure & Kidney Health Checks & Care in Indigenous Communities Presentation for Health Care Staff & Health Stakeholders

Kidney Health in Canada 1 in 10 Canadians has kidney problems Almost 1 in 3 First Nations adults have kidney problems 15% of First Nations children showed signs that kidney problems were starting Diabetes & high blood pressure are the leading causes There is increasing kidney failure and use of dialysis over the last 20 years

Kidney Health in Manitoba 2012 2024 2015 report predicted rapid growth of dialysis and transplant patient populations Between 2010 and 2017, Manitoba’s dialysis patient population grew by almost 35 per cent. 6

Kidney Health in Manitoba More impact on central & northern Manitoba Kidney Care Project wants to bring more PREVENTION efforts to these areas 6

Kidney Health & Indigenous Communities First Nations people are impacted by chronic kidney disease (CKD) and end-stage kidney disease May have to relocate to another community/city to receive dialysis treatment

Getting & Keeping Kidneys Healthy How can we work together to help improve health How do we help keep kidneys healthy so people don’t have to leave for dialysis How do we prevent kidney failure

Bringing kidney, diabetes and blood pressure testing to rural and remote Indigenous Communities in Canada Mobile health-care teams do the testing that provides on-the-spot results for adults and children Test results provided right away A kidney health plan is created Follow up care is arranged, if needed

Why Kidney Health Screening? Results in under 1 hour Catch kidney disease early Catch & treat risk factors Treatment to keep kidneys working PREVENT or delay dialysis

Who Should be Screened? Kids ages 10 - 18 All adults Health problems that can lead to kidney damage can start at younger ages All adults Unless already being treated by a kidney doctor

What’s Involved? Community leadership/stakeholder engagement & feedback Community engagement, kidney health education and discussion Kidney, diabetes & blood pressure testing and risk assessment Test result education & follow up care Report back to community

Indigenous Leadership & Partners Using First Nation organization developed and implemented model of care (Diabetes Integration Project) Working with people with lived experience with kidney disease working as partners on the project Community leadership and community members help guide plans and set priorities for their community

Manitoba Partners Participating Communities CanSOLVE CKD & Indigenous Patient Engagement Research Council Members Diabetes Integration Project – First Nations Health & Social Secretariat of Manitoba Chronic Disease Innovation Centre – SOGH Manitoba Renal Program Kidney Foundation of Canada Manitoba Branch Research Manitoba Children's Hospital Research Institute of Manitoba Four Arrows Regional Health Authority

Model of Care Based on Diabetes Integration Project which delivers diabetes screening to many First Nations in MB: First Nation directed Understanding of holistic health Culturally Safe Care Therapeutic Relationship A non-deficit approach Recognition and understanding of the many determinants that influence the health of the individual, family and community.

Testing Process

Point of Care Testing On site results using portable equipment & custom-built app Rapid testing = 10 -12 min Finger prick for blood and small urine sample eGFR, Urine ACR, HgbA1C

Kidney Failure Risk Equation Tangri et al. 2011 Developed by Manitoba doctor Used internationally

Results: Risk Based

Results: Risk Based

Follow Up: Team Approach Low Risk Patients Team: Primary care provider Focus: Lifestyle blood pressure Medium Risk Patients Team: Primary Care providers Kidney specialist Focus: Diagnosis Lifestyle Blood pressure Protein leak reduction High Risk Patients Team: Multidisciplinary Kidney Health Clinic Primary care provider* Kidney specialist Kidney Nurse Kidney Dietitian Kidney Pharmacist Kidney Social worker Focus: Healthy Lifestyle Reduction of blood pressure Reduction of protein leak in the urine Treat consequences of low kidney function Treat related heart and diabetic diseases

Kidney Care Team Clinical Pathways Example Only

Possible Treatments/ Kidney Health Plans Healthy Lifestyle Diet and exercise Traditional Diets/Medicines? Reduction of blood pressure to less than 130/80 Low salt diet Medications Reduction of protein leak in the urine (proteinuria) Medications - ACE inhibitors and ARBs Treatment of consequences of low kidney function Low red cell counts (anemia) Low calcium and high phosphate and potassium Treatment of related diseases Risk factors for heart disease Sugar control in diabetics SGLT-2 inhibitors

Changing Kidney Health Outcomes before Focused efforts on prevention and early treatment make a difference and can improve health outcomes. (Graph: U.S. implemented kidney health interventions for American Indian populations) after

Screening Results in Children Screening for kidney disease in indigenous Canadian children: The FINISHED screen, triage and treat program

Kidney Health Plan to Change your Chance of Kidney Failure (Click to animate) No Current Risk Low Intermediate High

Diagnosis & Treatment = Prevention

What we need to know: Best space for screening – amount of space needed Storing equipment/supplies Transport, moving equipment, taking appointments How to engage community members to get tested, any potential barriers? Best ways to screen children/get consent Timelines

Next Steps Now/ASAP: Future: Dates/times/space for testing event Community meeting / kidney health fair to engage community Future: Mobile Kidney Care Testing Report back to community Demonstrating effectiveness & cost-efficiency of kidney health screening in First Nations communities for long-term funding

Kidney Check is part of the CanSOLVE CKD Network Across-Canada patient-oriented kidney research network Working to transform treatment and care for Canadians living with or at risk for chronic kidney disease By participating in Kidney Care you are part of a national effort to improve kidney health care Cansolveckd.ca

Questions?