A five-year research project focusing on the impact of kidney disease in rural and remote First Nations communities in Manitoba has received $1.5 million in funding from the federal government’s Canadian Institutes of Health Research. The ‘Improving responsiveness across the continuum of kidney health care in rural and remote Manitoba First Nation communities’ (I-KHealth) project will be led by experts from Nanaandawewigamig’s (First Nations Health & Social Secretariat of Manitoba) Diabetes Integration Project (DIP), Ongomiizwin Research, Manitoba Renal Program, the University of Manitoba and the Manitoba Centre for Health Policy.

I-KHealth will deliver several studies which will review, evaluate and strategize kidney health approaches for First Nations individuals living in rural and remote areas of the province.

While one in 10 Canadians has some degree of kidney disease, for First Nations people in Manitoba that number is one in three. Manitoba has some of the highest rates of end-stage kidney disease (ESKD) across Canada which is contributing to a growing population of people requiring life-sustaining dialysis. In Manitoba, the dialysis patient population has grown by more than 35 per cent over the past eight years.

PRINCIPAL INVESTIGATORS

While the project’s researchers know there are a variety of reasons for the disparity – such as low socio-economic status, institutional racism and the continued effects of colonization as well as remoteness – they want to explore tangible ways to improve kidney health outcomes for First Nations people in rural and remote areas.

 “We all know the health status of Indigenous people when it comes to chronic diseases, and access to primary health care is a huge issue for isolated and remote communities,” explains co-principal investigator Caroline Chartrand.

The project has four components including mapping patient journeys for First Nations people living in rural and remote areas, assessing primary health care’s role in kidney health, evaluating and developing appropriate kidney health education and exploring alternative models of dialysis treatment delivery.

“It’s important to look at kidney health care in the context of existing systems to determine exactly what we can do better to slow or stop the devastating impact of kidney failure for First Nations communities in Manitoba,” explains co-principal investigator Dr. Josée Lavoie.

While a diagnosis of kidney disease is life-changing, a diagnosis in an earlier stage of chronic kidney disease (CKD) can lead to interventions that help manage the disease and reduce the possibility of progressing to later stages and the need for dialysis.

“There is a lot we can do to manage kidney health and delay dialysis when there is still a fair amount of kidney function left. What we are seeing, though, is people coming in with no prior contact with the kidney health team and significant loss of kidney function needing urgent dialysis.  At that point options are limited and the system has failed these patients,” explains co-principal investigator Dr. James Zacharias. “We know dialysis patients experience huge challenges in quality of life and some have to relocate entirely for dialysis treatment. The goal is to work alongside Indigenous patients and communities, as well as Indigenous health service providers and researchers, to find realistic and appropriate ways to address system issues and reduce the burden of kidney disease in rural and remote First Nations communities.”

One of IK-Health’s studies will look at what happened to patients who access health-care services with  ESKD, and who have little knowledge of their declining kidney function. Areas that will be explored include missed opportunities for prevention of ESKD, interactions with health-care systems prior to an ESKD diagnosis, as well as experiences with and access to primary health care.

DIP will lead another study that examines the journeys of patients who are diagnosed as being at low to medium risk for future kidney problems and how primary care or screening programs affect outcomes. This will include looking at the differences in availability of care and programs in various areas of the province and also discussing factors or barriers faced in accessing those resources.

“Upstream prevention efforts are key as the evidence points to the need to screen, triage and treat Indigenous people at the point of care and identify high risk clients to prevent the downstream costs of dialysis,” explains Chartrand. “Through a partnership with key specialty areas, DIP has successfully demonstrated the ability to refer clients directly to specialists bypassing the primary care system.”

The third study will evaluate existing education programs on kidney health both in communities and for kidney health clinic patients in the renal program. The study will look at how education is framed and delivered, and utilize First Nations patient knowledge to assess current resources and explore opportunities for improvement.

The last study of the project is exploring alternative models of dialysis delivery. Existing assisted peritoneal dialysis models will be evaluated and explored for feasibility to operate in rural and remote First Nations.

Another outcome of the project includes incorporating results into a Manitoba First Nations Kidney Health Strategy which will be developed in partnership with all stakeholders. The strategy will envision improved access and kidney care including proposed concrete care pathways tailored to the needs of First Nations communities that capitalize on the strengths of existing programs and services, such as Nanaandawewigamig’s DIP, Ongomiizwin Research and the Manitoba Renal Program.