Kidney disease and care among First Nations people with diabetes in Ontario: a population-based cohort study

Nash, Danielle M.; Dirk, Jade; McArthur, Eric; Green, Michael E.; Shah, Baiju R.; Walker, Jennifer; Beaucage, Mary; Jones, Carmen; Garg, Amit

doi:10.9778/cmajo.20190164

Cited by 6 publications

(5 citation statements)

References 21 publications

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“…Because the OLIS data were acquired at ICES during the present study, we were unable to perform any longitudinal analysis of the links between the levels of glycemic control we observed and the high rates of complications reported in our other papers. [8][9][10][11][12] However, it is highly likely that HbA 1c level sare an important driver of the observed differences in outcomes, given the well-known strong association between glycemic control and complications of diabetes. Leiter and colleagues 47 highlighted the difficulties in achieving glycemic control in their recent report combining results from the Diabetes Mellitus Assessment of Clinical Management in Ontario (DM-ACTION) and Diabetes Mellitus Improving Patient Care in Our Communities (DM-IMPACT) studies.…”

Section: Discussionmentioning

confidence: 99%

Monitoring, treatment and control of blood glucose and lipids in Ontario First Nations people with diabetes

Green¹,

Shah²,

Slater³

et al. 2020

CMAJ

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D iabetes and its related complications are major contributors to morbidity and mortality worldwide. 1-3 Indigenous populations in Canada and around the world are disproportionately affected by diabetes owing to the complex relations among colonization, social disadvantage, stress, trauma and metabolic health. 4-7 In addition to our own work showing persistently higher rates of peripheral vascular disease, stroke, cardiac disease, renal dysfunction and ophthalmologic complications in Ontario First Nations, 8-12 other Canadian and international studies also showed higher complication rates in diverse Indigenous populations. 6,7,13-15 Glycemic control is fundamental to the management of diabetes and the prevention of complications. 16 Glycated hemoglobin (A 1c) is a reliable way to estimate the average level of glucose in the blood. 17 Since A 1c levels higher than 7.0% have been associated with an increased risk of microvascular complications, 18-20 treatment guidelines suggest A 1c should be measured every 3-6 months to ensure that glycemic goals are being met or maintained. 21 Since people with diabetes also have an elevated risk for cardiovascular disease, 22-24 management and control of cardiovascular risk factors, particularly lipids such as low-density lipoprotein (LDL) cholesterol, are also important. 25-27 Guidelines further recommend that a full lipid profile be measured every 1-3 years, depending on cardiovascular risk, and suggest that LDL be consistently less than 2.0 mmol/L. 28 Control of A 1c and lipids has been shown to be associated with reduced morbidity and mortality in patients with diabetes. 18,29-32 One possible reason for the high burden of complications among Indigenous people with diabetes may be failure to achieve control of these 2 key clinical parameters. We examined differences between Status First Nations people with diabetes in Ontario and all other Ontario residents with diabetes in rates of monitoring of A 1c and lipids, achievement of targets for A 1c and LDL outlined in clinical guidelines, and patterns of medication use to help attain these targets.

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Section: Discussionmentioning

confidence: 99%

Monitoring, treatment and control of blood glucose and lipids in Ontario First Nations people with diabetes

Green¹,

Shah²,

Slater³

et al. 2020

CMAJ

Self Cite

View full text Add to dashboard Cite

show abstract

“…24 Indigenous patients are more likely to have an earlier onset of chronic kidney disease (CKD), to have diabetes either as a comorbid condition or as the cause of their CKD, and to travel further to receive kidney care compared with non-Indigenous patients. 24 - 27 There is also a higher prevalence of severe CKD among Indigenous patients compared with non-Indigenous patients in Canada. 25 - 27 While it has been noted that Indigenous peoples have substantially reduced access to KT and LDKT, 12 , 24 the specific factors leading to this inequitable access have not been fully characterized or understood.…”

Section: Introductionmentioning

confidence: 99%

“…24 - 27 There is also a higher prevalence of severe CKD among Indigenous patients compared with non-Indigenous patients in Canada. 25 - 27 While it has been noted that Indigenous peoples have substantially reduced access to KT and LDKT, 12 , 24 the specific factors leading to this inequitable access have not been fully characterized or understood. Furthermore, there have been few targeted efforts to improve equitable access to KT and LDKT for Indigenous communities in Canada.…”

Section: Introductionmentioning

confidence: 99%

Barriers to Accessing Kidney Transplantation Among Populations Marginalized by Race and Ethnicity in Canada: A Scoping Review Part 1—Indigenous Communities in Canada

El-Dassouki

Wong

Toews

et al. 2021

Can J Kidney Health Dis

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Background: Kidney transplantation (KT), a treatment option for end-stage kidney disease (ESKD), is associated with longer survival and improved quality of life compared with dialysis. Inequities in access to KT, and specifically, living donor kidney transplantation (LDKT), have been documented in Canada along various demographic dimensions. In this article, we review existing evidence about inequitable access and barriers to KT and LDKT for patients from Indigenous communities in Canada. Objective: To characterize the current state of literature on access to KT and LDKT among Indigenous communities in Canada and to answer the research question, “what factors may influence inequitable access to KT among Indigenous communities in Canada.” Eligibility criteria: Databases and gray literature were searched in June and November 2020 for full-text original research articles or gray literature resources addressing KT access or barriers in Indigenous communities in Canada. A total of 26 articles were analyzed thematically. Sources of evidence: Gray literature and CINAHL, OVID Medline, OVID Embase, and Cochrane databases. Charting methods: Literature characteristics were recorded and findings which described rates of and factors that influence access to KT were summarized in a narrative account. Key themes were subsequently identified and synthesized thematically in the review. Results: Indigenous communities in Canada experience various barriers in accessing culturally safe medical information and care, resulting in inequitable access to KT. Barriers include insufficient incorporation of Indigenous ways of knowing and being in information dissemination and care for ESKD and KT, spiritual concerns, health beliefs, logistical hurdles to accessing care, and systemic mistrust resulting from colonialism and systemic racism. Limitations: This review included studies that used various methodologies and did not assess study quality. Data on Indigenous status were not reported or defined in a standardized manner. Indigenous communities are not homogeneous and views on organ donation and KT vary by individual. Conclusions: Our scoping review has identified potential barriers that Indigenous communities may face in accessing KT and LDKT. Further research is urgently needed to better understand barriers and support needs and to develop strategies to improve equitable access to KT and LDKT for Indigenous populations in Canada.

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“…Indigenous peoples in Canada, and globally, experience much higher rates of end-stage renal disease (ESRD) than their non-Indigenous counterparts. In Ontario, 2.9% of First Nations peoples are diagnosed with ESRD compared with only 1.0% of non-Indigenous peoples ( 1 – 9 ). Indigenous people in Canada also have higher death rates due to chronic kidney disease (CKD) and ESRD ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

Understanding Barriers to Implementing and Managing Therapeutic Diets for People Living with Chronic Kidney Disease in Remote Indigenous Communities

Schiff

Freill

Hardy

2021

Current Developments in Nutrition

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Indigenous peoples in Canada, and globally, experience a disproportionate burden of chronic kidney disease (CKD) and end-stage renal disease (ESRD) ESRD patients in remote Indigenous communities might experience significant challenges in adhering to dietary guidelines. Much research has documented the poor quality, high cost, and limited availability of healthy foods in remote, Indigenous communities. Food quality and availability are poor in remote communities, indicating that persons with ESRD and CKD might have limited ability to adhere to dietary guidelines. This article reports on research designed to understand food-access barriers in remote First Nations for persons living with stage 4 and 5 CKD/ESRD. The study involved semi-structured interviews with 38 patients in remote communities. It concludes with some reflections on the significance of this issue in the context of dietetic practice.

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Kidney disease and care among First Nations people with diabetes in Ontario: a population-based cohort study

Cited by 6 publications

References 21 publications

Monitoring, treatment and control of blood glucose and lipids in Ontario First Nations people with diabetes

Monitoring, treatment and control of blood glucose and lipids in Ontario First Nations people with diabetes

Barriers to Accessing Kidney Transplantation Among Populations Marginalized by Race and Ethnicity in Canada: A Scoping Review Part 1—Indigenous Communities in Canada

Understanding Barriers to Implementing and Managing Therapeutic Diets for People Living with Chronic Kidney Disease in Remote Indigenous Communities

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