1. A pediatric kidney disease and diabetes screening program in rural and remote Indigenous Canadian communities was associated with increased laboratory testing, medication prescribing, and visits to primary care or nephrology, at the follow-up points of 18 and 33 months after the program.
Evidence Rating Level: 2 (Good)
In Canada, significant disparities in health outcomes exist between Indigenous and non-Indigenous populations. For instance, the prevalence of diabetes and chronic kidney disease (CKD) is 20% and 25.5% respectively in Indigenous peoples, which is two to five times higher than the general population. Due to inequities in the social determinants of health, CKD risk factors such as hypertension, obesity, and diabetes appear earlier in Indigenous populations. Although early CKD may be asymptomatic in children and interventions are more effective when started earlier, it is currently not recommended in Canada to do CKD screening in the general pediatric population. But this does not apply to higher risk populations, and Indigenous communities have CKD rates comparable to populations in other parts of the world, where screening has been successful. The current prospective study based out of Manitoba, Canada examined a diabetes and kidney health screening program in 13 rural/remote Indigenous communities, looking at the rates of screening before and after the intervention, and the program’s general impact on disease surveillance. The program involved community engagement, and consisted of deploying mobile teams to assess the following in children between 10 and 17 years of age: Blood pressure, body mass index, hemoglobin A1C (HbA1C), estimated glomerular filtration rate (eGFR), and urine albumin-to-creatinine ratio. The study analyzed the proportions of patients 18 months before the intervention and 18 months after, that went through laboratory testing, received medication prescriptions, and visited primary care or nephrology. In total, 353 children were screened, with 334 having data utilized in the study. 648 control patients were identified, matched by age, sex, location, and chronic disease prevalence. In terms of laboratory testing, the proportion of those receiving at least 1 eGFR test rose from 11.4% to 21.3% (95% CI 4.2% -15.5% increase),HbA1C testing rose from 6.8 to 12.4% (95% CI 1.1-10.1%), and urine albumin-to-creatinine ratio testing rose from 3.7 to 9.9% (95% CI 2.3-10.0%). There was a risk difference of 7.1% in eGFR testing compared to the control group (95% CI 0.9-11.1%) and a 4.8% difference in HbA1C testing (95% CI 0.2-9.4%). In terms of prescription medications, fewer than 6 patients received antihypertensive medication prior to the program, growing to 9 patients (2.8%) 18 months after, and 15 patients (4.6%) 33 months after. With antihyperglycemic medication, there were fewer than 6 patients before the program, 7 patients (2.2%) 18 months after, and 11 patients (3.4%) 33 months after. Lastly, visits to primary care for any reason grew from 52.8% to 59.3% (95% CI -1.1 to 14.1%), increasing to 79.3% after 33 months. Primary care visits for chronic disease rose from 3.1 to 7.4% (95% CI 0.2-7.2%), and up to 9.9% after 33 months. There were fewer than 6 nephrology visits before the screening program, which rose to 8 visits (2.5%) 18 months after, and 11 visits (3.4%) 33 months later. Overall, this study showed that this mobile screening program in rural/remote Indigenous communities increased the rate of laboratory testing, medication prescribing, and visits to primary care or nephrology, in the subsequent 18 and 33 months following the program.
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