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

2. 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

3. 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

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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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.

14. Testing Process

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

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

17. Results: Risk Based

18. Results: Risk Based

19. 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

20. Kidney Care Team Clinical Pathways
Example Only

21. 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

22. 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

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

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

25. Diagnosis & Treatment = Prevention

26. 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

27. 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

28. 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

29. Questions?