1
|
Schiff R, Freill H, Hardy CN. Understanding Barriers to Implementing and Managing Therapeutic Diets for People Living with Chronic Kidney Disease in Remote Indigenous Communities. Curr Dev Nutr 2021; 5:nzaa175. [PMID: 33501402 PMCID: PMC7809360 DOI: 10.1093/cdn/nzaa175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/18/2020] [Accepted: 12/02/2020] [Indexed: 11/13/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Rebecca Schiff
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - Holly Freill
- Renal Department, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Crystal N Hardy
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| |
Collapse
|
2
|
Wilkinson E, Brettle A, Waqar M, Randhawa G. Inequalities and outcomes: end stage kidney disease in ethnic minorities. BMC Nephrol 2019; 20:234. [PMID: 31242862 PMCID: PMC6595597 DOI: 10.1186/s12882-019-1410-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 06/06/2019] [Indexed: 02/08/2023] Open
Abstract
Background The international evidence about outcomes of End Stage Kidney Disease (ESKD) for ethnic minorities was reviewed to identify gaps and make recommendations for researchers and policy makers. Methods Nine databases were searched systematically with 112 studies from 14 different countries included and analysed to produce a thematic map of the literature. Results Reviews (n = 26) highlighted different mortality rates and specific causes between ethnic groups and by stage of kidney disease associated with individual, genetic, social and environmental factors. Primary studies focussing on uptake of treatment modalities (n = 19) found ethnic differences in access. Research evaluating intermediate outcomes and quality of care in different treatment phases (n = 35) e.g. dialysis adequacy, transplant evaluation and immunosuppression showed ethnic minorities were disadvantaged. This is despite a survival paradox for some ethnic minorities on dialysis seen in studies of longer term outcomes (n = 29) e.g. in survival time post-transplant and mortality. There were few studies which focussed on end of life care (n = 3) and ethnicity. Gaps identified were: limited evidence from all stages of the ESKD pathway, particularly end of life care; a lack of system oriented studies with a reliance on national routine datasets which are limited in scope; a dearth of qualitative studies; and a lack studies from many countries with limited cross country comparison and learning. Conclusions Differences between ethnic groups occur at various points and in a variety of outcomes throughout the kidney care system. The combination of individual factors and system related variables affect ethnic groups differently indicating a need for culturally intelligent policy informed by research to prevent disadvantage.
Collapse
Affiliation(s)
- Emma Wilkinson
- Institute for Health Research, University of Bedfordshire, Luton, Bedfordshire, UK
| | - Alison Brettle
- School of Health and Society, University of Salford, Manchester, UK
| | - Muhammad Waqar
- Institute for Health Research, University of Bedfordshire, Luton, Bedfordshire, UK
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, Bedfordshire, UK.
| |
Collapse
|
3
|
Gao A, Osgood ND, Jiang Y, Dyck RF. Projecting prevalence, costs and evaluating simulated interventions for diabetic end stage renal disease in a Canadian population of aboriginal and non-aboriginal people: an agent based approach. BMC Nephrol 2017; 18:283. [PMID: 28870154 PMCID: PMC5584022 DOI: 10.1186/s12882-017-0699-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 08/22/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Diabetes-related end stage renal disease (DM-ESRD) is a devastating consequence of the type 2 diabetes epidemic, both of which disproportionately affect Indigenous peoples. Projecting case numbers and costs into future decades would help to predict resource requirements, and simulating hypothetical interventions could guide the choice of best practices to mitigate current trends. METHODS An agent based model (ABM) was built to forecast First Nations and non-First Nations cases of DM-ESRD in Saskatchewan from 1980 to 2025 and to simulate two hypothetical interventions. The model was parameterized with data from the Canadian Institute for Health Information, Saskatchewan Health Administrative Databases, the Canadian Organ Replacement Register, published studies and expert judgement. Input parameters without data sources were estimated through model calibration. The model incorporated key patient characteristics, stages of diabetes and chronic kidney disease, renal replacement therapies, the kidney transplant assessment and waiting list processes, costs associated with treatment options, and death. We used this model to simulate two interventions: 1) No new cases of diabetes after 2005 and 2) Pre-emptive renal transplants carried out on all diabetic persons with new ESRD. RESULTS There was a close match between empirical data and model output. Going forward, both incidence and prevalence cases of DM-ESRD approximately doubled from 2010 to 2025, with 250-300 new cases per year and almost 1300 people requiring RRT by 2025. Prevalent cases of First Nations people with DM-ESRD increased from 19% to 27% of total DM-ESRD numbers from 1990 to 2025. The trend in yearly costs paralleled the prevalent DM-ESRD case count. For Scenario 1, despite eliminating diabetes incident cases after 2005, prevalent cases of DM-ESRD continued to rise until 2019 before slowly declining. When all DM-ESRD incident cases received a pre-emptive renal transplant (scenario 2), a substantial increase in DM-ESRD prevalence occurred reflecting higher survival, but total costs decreased reflecting the economic advantage of renal transplantation. CONCLUSIONS This ABM can forecast numbers and costs of DM-ESRD in Saskatchewan and be modified for application in other jurisdictions. This can aid in resource planning and be used by policy makers to evaluate different interventions in a safe and economical manner.
Collapse
Affiliation(s)
- Amy Gao
- Strategic Planning and Data Warehousing, University of Alberta, Edmonton, Canada
| | - Nathaniel D. Osgood
- Department of Computer Science, University of Saskatchewan, Saskatoon, Canada
| | | | - Roland F. Dyck
- Department of Medicine (Canadian Center for Health and Safety in Agriculture), University of Saskatchewan, Saskatoon, Canada
| |
Collapse
|
4
|
Persistent Albuminuria in Children with Type 2 Diabetes: A Canadian Paediatric Surveillance Program Study. J Pediatr 2016; 168:112-117. [PMID: 26470688 DOI: 10.1016/j.jpeds.2015.09.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 08/05/2015] [Accepted: 09/10/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the prevalence and the clinical features associated with persistent albuminuria in Canadian children aged <18 years with type 2 diabetes. STUDY DESIGN This national prospective surveillance study involved a network of pediatricians and pediatric endocrinologists. Cases of persistent albuminuria in children with type 2 diabetes were reported during a 24-month period from 2010 to 2012. Persistent albuminuria was defined as an elevated albumin-to-creatinine ratio in a minimum of 2 out of 3 urine samples obtained at least 1 month apart over 3-6 months and confirmed with a first morning sample. Descriptive statistics were used to illustrate demographic and clinical features of the population. The prevalence of persistent albumuria was estimated using data from a previous national surveillence study of type 2 diabetes in children. RESULTS Fifty cases were reported over the 24-month study period. The estimated prevalence of persistent albuminuria in children with type 2 diabetes in Canada was 5.1%. The median duration of diabetes at the time of diagnosis of albuminuria was 21 days (IQR, 0-241 days). Almost two-thirds (64%) were female, 80% were of Canadian First Nations heritage, and 76% were from Manitoba. Exposure to gestational or pregestational diabetes in utero occurred in 65%, and 48% had a family history of diabetes-related renal disease. Structural anomalies of the kidney were found in 37%. CONCLUSION Persistent albuminuria occurs in youths with type 2 diabetes in the first year after diagnosis, demonstrates regional variation, and is associated with First Nations heritage and exposure to maternal diabetes during pregnancy.
Collapse
|
5
|
Marchildon GP, Katapally TR, Beck CA, Abonyi S, Episkenew J, Pahwa P, Dosman JA. Exploring policy driven systemic inequities leading to differential access to care among Indigenous populations with obstructive sleep apnea in Canada. Int J Equity Health 2015; 14:148. [PMID: 26683058 PMCID: PMC4683910 DOI: 10.1186/s12939-015-0279-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/08/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND In settler societies such as Australia, Canada, New Zealand and the United States, health inequities drive lower health status and poorer health outcomes in Indigenous populations. This research unravels the dense complexity of how historical policy decisions in Canada can influence inequities in health care access in the 21(st) century through a case study on the diagnosis and treatment of obstructive sleep apnea (OSA). In Canada, historically rooted policy regimes determine current discrepancies in health care policy, and in turn, shape current health insurance coverage and physician decisions in terms of diagnosis and treatment of OSA, a clinical condition that is associated with considerable morbidity in Canada. METHODS This qualitative study was based in Saskatchewan, a Western Canadian province which has proportionately one of the largest provincial populations of an Indigenous subpopulation (status Indians) which is the focus of this study. The study began with determining approaches to OSA care provision based on Canadian Thoracic Society guidelines for referral, diagnosis and treatment of sleep disordered breathing. Thereafter, health policy determining health benefits coverage and program differences between status Indians and other Canadians were ascertained. Finally, respirologists who specialized in sleep medicine were interviewed. All interviews were audio-recorded and the transcripts were thematically analyzed using NVIVO. RESULTS In terms of access and provision of OSA care, different patient pathways emerged for status Indians in comparison with other Canadians. Using Saskatchewan as a case study, the preliminary evidence suggests that status Indians face significant barriers in accessing diagnostic and treatment services for OSA in a timely manner. CONCLUSIONS In order to confirm initial findings, further investigations are required in other Canadian jurisdictions. Moreover, as other clinical conditions could share similar features of health care access and provision of health benefits coverage, this policy analysis could be replicated in other provincial and territorial health care systems across Canada, and other settler nations where there are differential health coverage arrangements for Indigenous peoples.
Collapse
Affiliation(s)
- Gregory P Marchildon
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Tarun R Katapally
- Johnson Shoyama Graduate School of Public Policy, University of Regina, Regina, Canada.
- Indigenous Peoples' Health Research Centre, University of Regina, Regina, Canada.
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada.
| | - Caroline A Beck
- Johnson Shoyama Graduate School of Public Policy, University of Regina, Regina, Canada.
| | - Sylvia Abonyi
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Canada.
| | - JoAnn Episkenew
- Indigenous Peoples' Health Research Centre, University of Regina, Regina, Canada.
| | - Punam Pahwa
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada.
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Canada.
| | - James A Dosman
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada.
| |
Collapse
|
6
|
Dyck RF, Karunanayake C, Janzen B, Lawson J, Ramsden VR, Rennie DC, Gardipy PJ, McCallum L, Abonyi S, Dosman JA, Episkenew JA, Pahwa P. Do discrimination, residential school attendance and cultural disruption add to individual-level diabetes risk among Aboriginal people in Canada? BMC Public Health 2015; 15:1222. [PMID: 26651995 PMCID: PMC4675031 DOI: 10.1186/s12889-015-2551-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 11/30/2015] [Indexed: 01/25/2023] Open
Abstract
Background Aboriginal peoples in Canada (First Nations, Metis and Inuit) are experiencing an epidemic of diabetes and its complications but little is known about the influence of factors attributed to colonization. The purpose of this study was to investigate the possible role of discrimination, residential school attendance and cultural disruption on diabetes occurrence among First Nations adults. Methods This 2012/13 cross sectional survey was conducted in two Saskatchewan First Nations communities comprising 580 households and 1570 adults. In addition to self-reported diabetes, interviewer-administered questionnaires collected information on possible diabetes determinants including widely recognized (e.g. age, sex, lifestyle, social determinants) and colonization-related factors. Clustering effect within households was adjusted using Generalized Estimating Equations. Results Responses were obtained from 874 (55.7 %) men and women aged 18 and older living in 406 (70.0 %) households. Diabetes prevalence was 15.8 % among women and 9.7 % among men. In the final models, increasing age and adiposity were significant risk factors for diabetes (e.g. OR 8.72 [95 % CI 4.62; 16.46] for those 50+, and OR 8.97 [95 % CI 3.58; 22.52] for BMI 30+) as was spending most time on-reserve. Residential school attendance and cultural disruption were not predictive of diabetes at an individual level but those experiencing the most discrimination had a lower prevalence of diabetes compared to those who experienced little discrimination (2.4 % versus 13.6 %; OR 0.11 [95 % CI 0.02; 0.50]). Those experiencing the most discrimination were significantly more likely to be married and to have higher incomes. Conclusions Known diabetes risk factors were important determinants of diabetes among First Nations people, but residential school attendance and cultural disruption were not predictive of diabetes on an individual level. In contrast, those experiencing the highest levels of discrimination had a low prevalence of diabetes. Although the reasons underlying this latter finding are unclear, it appears to relate to increased engagement with society off-reserve which may lead to an improvement in the social determinants of health. While this may have physical health benefits for First Nations people due to improved socio-economic status and other undefined influences, our findings suggest that this comes at a high emotional price.
Collapse
Affiliation(s)
- Roland F Dyck
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, Saskatchewan, S7N 2Z4, Canada. .,Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. .,Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Chandima Karunanayake
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, Saskatchewan, S7N 2Z4, Canada.
| | - Bonnie Janzen
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Josh Lawson
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, Saskatchewan, S7N 2Z4, Canada.
| | - Vivian R Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Donna C Rennie
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, Saskatchewan, S7N 2Z4, Canada.
| | | | - Laura McCallum
- William Charles Health Centre, Montreal Lake Cree Nation, Saskatchewan, Canada.
| | - Sylvia Abonyi
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - James A Dosman
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, Saskatchewan, S7N 2Z4, Canada.
| | - Jo-Ann Episkenew
- Indigenous Peoples' Health Research Centre, University of Regina, Regina, Canada.
| | - Punam Pahwa
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, Saskatchewan, S7N 2Z4, Canada. .,Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | | |
Collapse
|
7
|
Lloyd A, Komenda P. Optimizing care for Canadians with diabetic nephropathy in 2015. Can J Diabetes 2015; 39:221-8. [PMID: 25805325 DOI: 10.1016/j.jcjd.2014.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 11/12/2014] [Accepted: 11/13/2014] [Indexed: 12/30/2022]
Abstract
Diabetic chronic kidney disease (CKD) is the cause of kidney failure in approximately 35% of Canadian patients requiring dialysis. Traditionally, only a minority of patients with type 2 diabetes and CKD progress to kidney failure because they die of a cardiovascular event first. However, with contemporary therapies for diabetes and cardiovascular disease, this may no longer be true. The classic description of diabetic CKD is the development of albuminuria followed by progressive kidney dysfunction in a patient with longstanding diabetes. Many exciting candidate agents are under study to halt the progression of diabetic CKD; current therapies center on optimizing glycemic control, renin angiotensin system inhibition, blood pressure control and lipid management. Lifestyle modifications, such as salt and protein restriction as well as smoking cessation, may also be of benefit. Unfortunately, these accepted therapies do not entirely halt the progression of diabetic CKD. Also unfortunately, the presence of CKD in general is under-recognized by primary care providers, which can lead to late referral, missed opportunities for preventive care and inadvertent administration of potentially harmful interventions. Not all patients require referral to nephrology for diagnosis and management, but modern risk-prediction algorithms, such as the kidney failure risk equation, may help to guide referral appropriateness and dialysis modality planning in subspecialty nephrology multidisciplinary care clinics.
Collapse
Affiliation(s)
- Alissa Lloyd
- University of Manitoba, Department of Medicine, Section of Nephrology, Winnipeg, Canada
| | - Paul Komenda
- University of Manitoba, Department of Medicine, Section of Nephrology, Winnipeg, Canada; Seven Oaks General Hospital, Department of Nephrology, Winnipeg, Canada.
| |
Collapse
|
8
|
Komenda P, Yu N, Leung S, Bernstein K, Blanchard J, Sood M, Rigatto C, Tangri N. Secular trends in end-stage renal disease requiring dialysis in Manitoba, Canada: a population-based study. CMAJ Open 2015; 3:E8-E14. [PMID: 25844374 PMCID: PMC4382045 DOI: 10.9778/cmajo.20130034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND End-stage renal disease (ESRD) requiring dialysis is expensive and is associated with disproportionately poor health outcomes and quality of life. Understanding regional long-term secular trends in the incidence and prevalence of dialysis will allow for the alignment of appropriate and efficient delivery of care. The primary objective of this study was to describe long-term secular and geographic trends in ESRD over a 22-year period in a single-provider Canadian health care setting. METHODS Using a previously validated case definition, we described the annual incidence and prevalence of ESRD in Manitoba from 1989 to 2010, stratified by age, sex and geographic location within the province. RESULTS We searched more than 1.2 million records within the Manitoba Health repository. We identified 9489 patients in the Manitoba Health Physician Claims database with at least 1 claim for dialysis from 1989 through Mar. 31, 2010. Using the case definition of any 2 dialysis treatment claims, the total annual incidence of ESRD increased 2.5-fold from 15.8 to 40.2 per 100 000 during the study period. Of note, the northern rural portions of the province saw a 12-fold unadjusted increase in ESRD, from 8.1 per 100 000 in 1989 to 96.3 per 100 000 in 2009. INTERPRETATION The incidence and prevalence of ESRD is increasing in Manitoba, most notably in the north of the province. Innovative interventions, such as primary screening and treatment initiatives, should specially target northern rural regions.
Collapse
Affiliation(s)
- Paul Komenda
- Section of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Man. ; Seven Oaks General Hospital, Winnipeg, Man
| | - Nancy Yu
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Man
| | - Stella Leung
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Man
| | - Keevin Bernstein
- Section of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Man. ; Health Sciences Centre, Winnipeg, Man
| | | | - Manish Sood
- Section of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Man. ; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont
| | - Claudio Rigatto
- Section of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Man. ; Seven Oaks General Hospital, Winnipeg, Man
| | - Navdeep Tangri
- Section of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Man. ; Seven Oaks General Hospital, Winnipeg, Man. ; Department of Community Health Sciences, University of Manitoba, Winnipeg, Man
| |
Collapse
|
9
|
Dyck RF, Jiang Y, Osgood ND. The Long-Term Risks of End Stage Renal Disease and Mortality among First Nations and Non-First Nations People with Youth-Onset Diabetes. Can J Diabetes 2014; 38:237-43. [DOI: 10.1016/j.jcjd.2014.03.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 03/20/2014] [Accepted: 03/23/2014] [Indexed: 12/19/2022]
|
10
|
Harris SB, Bhattacharyya O, Dyck R, Hayward MN, Toth EL. Le diabète de type 2 chez les Autochtones. Can J Diabetes 2013. [DOI: 10.1016/j.jcjd.2013.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
11
|
|
12
|
Dyck RF, Naqshbandi Hayward M, Harris SB. Prevalence, determinants and co-morbidities of chronic kidney disease among First Nations adults with diabetes: results from the CIRCLE study. BMC Nephrol 2012; 13:57. [PMID: 22776036 PMCID: PMC3438064 DOI: 10.1186/1471-2369-13-57] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 06/18/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Indigenous peoples worldwide are experiencing elevated rates of type 2 diabetes and its complications. To better understand the disproportionate burden of diabetic end stage renal disease (ESRD) among Canadian First Nations people (FN), we examined prevalence, determinants, and co-morbidities of chronic kidney disease (CKD) within this population. METHODS The 2007 Canadian FN Diabetes Clinical Management and Epidemiologic (CIRCLE) study conducted a cross-sectional national medical chart audit of 885 FN adults with type 2 diabetes to assess quality of diabetes care. In this sub-study, participants were divided by estimated glomerular filtration rate (eGFR in ml/min/1.73 m2), as well as by albuminuria level in those with eGFRs = > 60. Those with eGFRs = > 60 and negative albuminuria were considered to have normal/near normal kidney function (non-CKD). Using univariate and logistic regression analysis, they were compared with participants having eGFRs = > 60 plus albuminuria (CKD-alb) and with participants having eGFRs <60 (CKD-eGFR <60). RESULTS While 84.5% of total CIRCLE participants had eGFRs = > 60, almost 60% of the latter had CKD-alb. Of the 15.5% of total participants with CKD-eGFR <60, 80% had eGFRs 30-60 (Stage 3 CKD) but over 10% (1.6% of total participants) had ESRD. Independent determinants of CKD-alb were male gender and increasing diabetes duration, systolic BP, A1C and total cholesterol. These plus smoking rates also discriminated between FN with micro- and macro-albuminuria. Independent determinants of CKD-eGFR <60 were increasing age at diabetes diagnosis, diabetes duration, total cholesterol and systolic BP. However, participants with CKD-eGFR <60 also displayed a decreasing mean age of diabetes diagnosis as eGFR declined. Micro-vascular co-morbidities were significantly associated with CKD-alb but both micro- and macro-vascular co-morbidities were associated with CKD-eGFR <60. Only 35-40% of participants with CKD used insulin. CONCLUSIONS High prevalences of CKD-alb and early CKD-eGFR <60 among diabetic FN were largely related to modifiable and treatable risk factors. However, an earlier age of diabetes diagnosis and longer duration of diabetes characterized those with ESRD. These findings suggest that a failure to meet current standards of diabetes care interacting with an age-related survival benefit contribute to the disproportionate burden of ESRD among FN and possibly other Indigenous peoples.
Collapse
Affiliation(s)
- Roland F Dyck
- Department of Medicine, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, S7N 5E5, Canada
| | - Mariam Naqshbandi Hayward
- Centre for Studies in Family Medicine, Department of Family Medicine, The University of Western Ontario, London, Ontario, N6G 4X8, Canada
| | - Stewart B Harris
- Centre for Studies in Family Medicine, Department of Family Medicine, The University of Western Ontario, London, Ontario, N6G 4X8, Canada
| |
Collapse
|
13
|
Decreased urine albumin:creatinine ratios in infants of diabetic mothers: does exposure to diabetic pregnancies alter fetal renal development? J Dev Orig Health Dis 2011; 2:265-71. [DOI: 10.1017/s2040174411000286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Offspring of diabetic mothers experience an increased risk for type 2 diabetes but it is not known whether diabetic pregnancies also confer a higher inter-generational risk for diabetic complications. Because microalbuminuria is a sensitive indicator of glomerular damage, we compared the urine albumin:creatinine ratios (ACRs) between 65 infants of diabetic mothers (InfDM+) and 59 infants of non-diabetic mothers (InfDM−), and repeated the comparisons in 21 InfDM+ and 19 InfDM− when children were 5–19 months old. ACRs were higher among neonates compared with normal reference values for adults, but declined with increasing age. The only independent predictor of higher ACRs in a logistic regression model (⩾13 mg/mmol v. <13 mg/mmol) was the presence of delivery complications (odds ratio 2.95; P = 0.015). Neither high nor low birth weight was associated with higher neonatal ACRs. The most unique finding of the study was that InfDM+ had significantly lower ACRs than InfDM− [mean = 12.9 (median = 6.0) v. mean = 16.6 (median = 11.5), respectively at P = 0.05] even after adjusting for other variables using logistic regression (odds ratio 0.25; P = 0.001). In contrast, by 5–19 months, there was a trend toward higher ACRs among InfDM+ compared with InfDM− [mean = 6.3 mg/mmol (median = 1.9) v. mean = 3.0 mg/mmol (median = 2.5), respectively at P = 0.25]. Lower ACRs in InfDM+ may be due to developmental changes in fetal kidneys induced by hyperinsulinemia. Although the implications of this observation are unclear, it is possible that exposure to a diabetic intrauterine environment might influence the later risk for renal disease.
Collapse
|