title: Assessment of the Siksika chronic disease nephropathy-prevention clinic.
abstract: OBJECTIVE
  To determine if a community-based multifactorial intervention clinic led by a nurse practitioner would improve management of First Nations people at risk of developing chronic kidney disease.
  
  
  METHODS
  Qualitative descriptive study.
  
  
  METHODS
  A nephropathy-prevention clinic in Siksika Nation, Alta.
  
  
  METHODS
  First Nations people with diabetes, hypertension, or dyslipidemia who were referred to the clinic.
  
  
  METHODS
  Changes in blood pressure (BP), hemoglobin A(1c), and low-density lipoprotein levels, as well as in use of antiplatelet therapy, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker medications, and statin therapy.
  
  
  RESULTS
  Members of the Siksika Nation were treated according to clinical practice guidelines. A total of 78 patients had at least 2 visits to the clinic and were included in this analysis (61.5% were women; mean age 56 years). Among those initially above target, a significant reduction was achieved in mean hemoglobin A(1c) (0.96%; P < .01), systolic BP (15.84 mm Hg; P < .05), diastolic BP (7.16 mm Hg; P < .001), and low-density lipoprotein (0.62 mmol/L; P < .01) levels. There was a significant increase in the proportion of patients with clinical indications who were treated with acetylsalicylic acid (42.4%; P < .01), angiotensin-converting enzyme inhibitor or angiotensin receptor blocker medications (35.9%; P < .01), or statin therapy (35.9%; P < .01).
  
  
  CONCLUSIONS
  A community-based, nurse practitioner-led clinic can improve many clinically relevant factors in patients at risk of developing chronic kidney disease. Studies have shown that achieving treatment targets is associated with a reduced risk of early death and cardiovascular events; the effect in the First Nations population on these hard clinical end points remains to be determined.
authors: Department of Medicine, University of Calgary, Alberta.
authors: David R R
authors: DR
authors: Ward
authors: Ellen
authors: E
authors: Novak
authors: Nairne
authors: N
authors: Scott-Douglas
authors: Sony
authors: S
authors: Brar
authors: Melvin
authors: M
authors: White
authors: Brenda R
authors: BR
authors: Hemmelgarn
mesh_terms: D000328:Adult; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D001794:Blood Pressure; D002170:Canada; D003920:Diabetes Mellitus / Q000188:drug therapy; D003928:Diabetic Nephropathies / Q000517:prevention & control*; D050171:Dyslipidemias / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy; D006977:Hypertension, Renal / Q000517:prevention & control*; D007198:Indians, North American; D008077:Lipoproteins, LDL; D008297:Male; D008875:Middle Aged; D009393:Nephritis / Q000517:prevention & control*; D015403:Nursing Evaluation Research; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D057184:Practice Patterns, Nurses'; D036301:Qualitative Research; D051436:Renal Insufficiency, Chronic / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D001241:Aspirin; D006442:Glycated Hemoglobin; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008077:Lipoproteins, LDL; D010975:Platelet Aggregation Inhibitors; C517652:hemoglobin A1c protein, human