A formal study into a medical screening program for Indigenous children from remote Canadian communities has found that the additional screening has been successful in increasing access to appropriate medical care for children who are at increased risk of diabetes and chronic kidney disease (CKD).
The research report, published Sept. 13 in the Canadian Medical Association Journal (CMAJ), outlined how screening was carried out to identify ways to help young people aged 10 to 17 years
The study was carried out by 11 physicians and researchers from several hospitals, universities and health-care agencies in Manitoba. The study included more than 300 children who were part of the screening intervention and additional laboratory testing procedures.
It was stated in a previous study, known as The Finished Program, that "Indigenous populations are disproportionately affected by kidney failure at younger ages than other ethnic groups in Canada. As symptoms do not occur until disease is advanced, early kidney disease risk is often unrecognized."
The study said the First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis project was a point-of-care screening program in rural and remote First Nations communities in Manitoba that aimed to identify and treat hypertension, diabetes and chronic kidney disease.
The study also said the program identified chronic disease in 20 per cent of children screened.
"Interventions such as active surveillance programs have the potential to improve the chronic disease care being provided to First Nations children," said the study.
"Substantial health disparities exist between Indigenous and non-Indigenous people in Canada. The prevalence of diabetes and chronic kidney disease (CKD) among Indigenous people in Canada is 20 per cent and 25.5 per cent (higher), respectively, which is two-to fivefold higher than the general population.
A previous study published in CMAJ (2019) involving First Nations residents in Northwestern Ontario reported more than 5,200 were tested and 14 per cent of them were found to have chronic kidney disease and most of that group, 80 per cent, were found to have cardiovascular comorbidities.
The study also touched on what it said was the "controversial issue" of screening for CKD in children given the uncertainty of its effectiveness.
Around the world, screening for CKD in children is a controversial issue, given the uncertainty of its effectiveness, said the CMAJ study. In Canada, screening for CKD in the general pediatric population is not currently recommended.
The controversy was outlined in a study in the Clinical Journal of the American Society of Nephrology.
The Canadian study said the CKD testing approach did not consider screening in high-risk populations (Indigenous) with reduced access to primary care resources.
"Manitoba has the highest rates of CKD in Canada, with a prevalence of 1,704 per million population, compared with the overall rate of 1,372 per million population in Canada,"
The study also reported that Canada's Indigenous population is over-represented with progression of kidney failure eight years sooner than non-Indigenous Canada.
The CMAJ report concluded that "the study provides evidence to support the introduction of active screening initiatives in pediatric First Nations communities, including biennial screening programs in primary care clinics, to help narrow the current gaps in the health-care system."
The full text of the CMAJ report can be found here.
Len Gillis is a Local Journalism Initiative reporter at Sudbury.com. He covers health care in Northern Ontario.
