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Mass screening for chronic kidney disease in rural and remote Canadian first nations people: methodology and demographic characteristics.

Lavallee B, Chartrand C, McLeod L, Rigatto C, Tangri N, Dart A, Gordon A, Ophey S, Komenda P - Can J Kidney Health Dis (2015)

Bottom Line: As of August 31, 2014, 1480 people in 11 communities over 2 Tribal Councils have been successfully screened.Further analysis of this cohort will describe theepidemiology of CKD in these communities, and test the cost effectiveness of this strategy.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Diabetes Integration Project, Winnipeg, Canada ; University of Manitoba, Centre for Aboriginal Health Education, Winnipeg, Canada.

ABSTRACT

Background: Screening the general population for Chronic Kidney Disease is not currently recommended.. Rural and remote Canadian First Nations people suffer a disproportionate burden of Kidney Failure. The Fi rst N at i ons Community Based S creening to Improve Kidney He alth and Prevent D ialysis ( FINISHED ) project intends to test the hypothesis that a mobile, mass screening initiative available to all First Nations people 10 years of age and older residing in rural and/or remote communities, is feasible, will improve health outcomes and is cost effective.

Objectives: The objective of this manuscript is to describe the key elements required to design, implement and evaluate such a program and describe key characteristics of our screened cohort.

Design: Methods and cohort description.

Setting: 11 First Nations communities within 2 Tribal Councils in Manitoba, Canada.

Patients: All First Nations individuals between the ages of 10-80 living in the 11communities were eligible for the screening initiative.

Measurements: Screening Rates achieved within communities.

Methods: An interdisciplinary team partnership was established between the Diabetes Integration Project and the Manitoba Renal Program. Stakeholder consultation was obtained and protocols developed to mass screen community members using point of care testing equipment. All people screened were risk stratified, counselled and referred to nephrologists as required in real time, based on risk.

Results: As of August 31, 2014, 1480 people in 11 communities over 2 Tribal Councils have been successfully screened. A mean screening rate of 21% of all community members eligible (aged 10-80) has been achieved. All patients at intermediate or high risk of kidney failure have been seen by nephrologists within 1 month of screening.

Limitations: Long term outcomes of kidney failure rates not assessed for at least 5 years. Alternative public health initiatives to reduce kidney failure not investigated.

Conclusions: Point of care mass screening, real time risk prediction and counselling of First Nations people at high risk of Kidney Failure is feasible in rural and remote communities. Further analysis of this cohort will describe theepidemiology of CKD in these communities, and test the cost effectiveness of this strategy.

No MeSH data available.


Related in: MedlinePlus

Adult screening paradigm.
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Fig2: Adult screening paradigm.

Mentions: All patient consents, demographic, blood pressure and biochemical data were entered at the point of care on to a tablet computer (iPad3, Apple, Cupertino, CA), using a secure customized application created specifically for this project by an in-house computer programmer. The data entered would automatically calculate a patient’s five-year risk of kidney failure as calculated by the Kidney Failure Risk Equation (KFRE) [27] for adult patients screened. Using data from the KFRE and a few other parameters such as level of proteinuria, adult (>18 yo) patients were assigned to a category of risk of low, intermediate or high corresponding to their 5 year risk of kidney failure and other parameters such as level of proteinuria for those with eGFR >60 ml/min/m [2]. (Figure 2). Risk based counselling scripts were developed and delivered by the screening teams in real time (Additional file 1).Figure 2


Mass screening for chronic kidney disease in rural and remote Canadian first nations people: methodology and demographic characteristics.

Lavallee B, Chartrand C, McLeod L, Rigatto C, Tangri N, Dart A, Gordon A, Ophey S, Komenda P - Can J Kidney Health Dis (2015)

Adult screening paradigm.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940863&req=5

Fig2: Adult screening paradigm.
Mentions: All patient consents, demographic, blood pressure and biochemical data were entered at the point of care on to a tablet computer (iPad3, Apple, Cupertino, CA), using a secure customized application created specifically for this project by an in-house computer programmer. The data entered would automatically calculate a patient’s five-year risk of kidney failure as calculated by the Kidney Failure Risk Equation (KFRE) [27] for adult patients screened. Using data from the KFRE and a few other parameters such as level of proteinuria, adult (>18 yo) patients were assigned to a category of risk of low, intermediate or high corresponding to their 5 year risk of kidney failure and other parameters such as level of proteinuria for those with eGFR >60 ml/min/m [2]. (Figure 2). Risk based counselling scripts were developed and delivered by the screening teams in real time (Additional file 1).Figure 2

Bottom Line: As of August 31, 2014, 1480 people in 11 communities over 2 Tribal Councils have been successfully screened.Further analysis of this cohort will describe theepidemiology of CKD in these communities, and test the cost effectiveness of this strategy.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Diabetes Integration Project, Winnipeg, Canada ; University of Manitoba, Centre for Aboriginal Health Education, Winnipeg, Canada.

ABSTRACT

Background: Screening the general population for Chronic Kidney Disease is not currently recommended.. Rural and remote Canadian First Nations people suffer a disproportionate burden of Kidney Failure. The Fi rst N at i ons Community Based S creening to Improve Kidney He alth and Prevent D ialysis ( FINISHED ) project intends to test the hypothesis that a mobile, mass screening initiative available to all First Nations people 10 years of age and older residing in rural and/or remote communities, is feasible, will improve health outcomes and is cost effective.

Objectives: The objective of this manuscript is to describe the key elements required to design, implement and evaluate such a program and describe key characteristics of our screened cohort.

Design: Methods and cohort description.

Setting: 11 First Nations communities within 2 Tribal Councils in Manitoba, Canada.

Patients: All First Nations individuals between the ages of 10-80 living in the 11communities were eligible for the screening initiative.

Measurements: Screening Rates achieved within communities.

Methods: An interdisciplinary team partnership was established between the Diabetes Integration Project and the Manitoba Renal Program. Stakeholder consultation was obtained and protocols developed to mass screen community members using point of care testing equipment. All people screened were risk stratified, counselled and referred to nephrologists as required in real time, based on risk.

Results: As of August 31, 2014, 1480 people in 11 communities over 2 Tribal Councils have been successfully screened. A mean screening rate of 21% of all community members eligible (aged 10-80) has been achieved. All patients at intermediate or high risk of kidney failure have been seen by nephrologists within 1 month of screening.

Limitations: Long term outcomes of kidney failure rates not assessed for at least 5 years. Alternative public health initiatives to reduce kidney failure not investigated.

Conclusions: Point of care mass screening, real time risk prediction and counselling of First Nations people at high risk of Kidney Failure is feasible in rural and remote communities. Further analysis of this cohort will describe theepidemiology of CKD in these communities, and test the cost effectiveness of this strategy.

No MeSH data available.


Related in: MedlinePlus