title: The Prevalence of CKD in Rural Canadian Indigenous Peoples: Results From the First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis (FINISHED) Screen, Triage, and Treat Program.
abstract: Indigenous Canadians have high rates of risk factors for chronic kidney disease (CKD), in particular diabetes. Furthermore, they have increased rates of complications associated with CKD, such as kidney failure and vascular disease. Our objective was to describe the prevalence of CKD in this population.
  
  
  
  Cross-sectional cohort.
  
  
  
  Indigenous (First Nations) Canadians 18 years or older screened as part of the First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis (FINISHED) project, an initiative completed in 2015 that accomplished community-wide screening in 11 rural communities in Manitoba, Canada.
  
  
  
  Indigenous ethnicity and geographic location (communities accessible by road compared with those accessible only by air).
  
  
  
  Prevalence of CKD, presumed based on a single ascertainment of urine albumin-creatinine ratio (UACR) ≥ 30mg/g and/or estimated glomerular filtration rate (eGFR)<60mL/min/1.73m(2).
  
  
  
  Kidney function measured by eGFR (CKD-EPI creatinine equation) and UACR.
  
  
  
  1,346 adults were screened; 25.5% had CKD, defined as UACR≥30mg/g or eGFR<60mL/min/1.73m(2). Communities accessible by road had a lower prevalence of CKD (17.6%) than more remote communities accessible only by air (34.4%). Of those screened, 3.3% had reduced kidney function (defined as eGFR<60mL/min/1.73m(2)). Severely increased albuminuria was present in 5.0% of those screened.
  
  
  
  Presumption of chronicity based on a single ascertainment. There is a possibility of sampling bias, the net direction of which is uncertain.
  
  
  
  We found a 2-fold higher prevalence of CKD in indigenous Canadians in comparison to the general population and a prevalence of severely increased albuminuria that was 5-fold higher. This is comparable to patients with diabetes and/or hypertension. Public health strategies to screen, triage, and treat all Canadian indigenous peoples with CKD should be considered.
authors.affiliation: Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: pkomenda@sbgh.mb.ca.
authors.forename: Paul
authors.initials: P
authors.lastname: Komenda
authors.affiliation: Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Diabetes Integration Project, Winnipeg, Manitoba, Canada. Electronic address: barry.lavallee@med.umanitoba.ca.
authors.forename: Barry
authors.initials: B
authors.lastname: Lavallee
authors.affiliation: Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Ferguson
authors.affiliation: Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Navdeep
authors.initials: N
authors.lastname: Tangri
authors.affiliation: Diabetes Integration Project, Winnipeg, Manitoba, Canada.
authors.forename: Caroline
authors.initials: C
authors.lastname: Chartrand
authors.affiliation: Diabetes Integration Project, Winnipeg, Manitoba, Canada.
authors.forename: Lorraine
authors.initials: L
authors.lastname: McLeod
authors.affiliation: Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada.
authors.forename: Audrey
authors.initials: A
authors.lastname: Gordon
authors.affiliation: Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Allison
authors.initials: A
authors.lastname: Dart
authors.affiliation: Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Claudio
authors.initials: C
authors.lastname: Rigatto
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007198:Indians, North American; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012423:Rural Health; D014218:Triage
keywords: Canada; First Nations; Screening; albuminuria; chronic kidney disease (CKD); early detection; estimated glomerular filtration rate (eGFR); health care access; health disparities; indigenous community; remote; renal impairment; rural; urine albumin-creatinine ratio (UACR)