Indigenous Population and Chronic Kidney Disease

Working in a hospital that has a first nation community, specifically supporting Chippewas of Rama First Nation, within its catchment area has allowed myself to become aware of health challenges faced by this population.

Some personal observations from my practice in acute medicine:

• turn to western medicine in hopes of support along with traditional practices

• often multiple family members dealing with chronic illness

• difficulty securing medication needed to treat

• more likely to sign out of the hospital against medical advice (specifically those who are iv drug users or have substance misuse disorder)

Although those are just my personal observations, I was surprised as I did farther research on this population and how their health is affected by being part of indigenous heritage. Not only does this population have increased risk, little is known about how educational materials are developed for them.

Common Chronic Diseases seen among Indigenous Populations include:

• Obesity: “58.3% living off-reserve are physically inactive; overweight and obesity is more common in adults Aboriginal Canadians than the general population; and 41.3% of children and youth off-reserve are overweight compared to 26.2% of general population” (Earle, 2013)

• Diabetes: rates for Indigenous populations living on reserve 8.5% versus 5.3% off reserve (Earle, 2013)

• Chronic Kidney Disease: effects 4 million Canadians (Levin et al, 2018) but higher rates among Indigenous population (Canadian Institute for Health Information, 2013)

Review of chronic kidney disease in Indigenous Population:

• More likely to be younger and suffer from co-morbidities, such as diabetes or obesity (Canadian Institute for Health Information, 2013)

• Socio-economic factors:1) Live in rural or remote areas needing to travel farther to receive treatment or information (Canadian Institute for Health Information, 2013; Jansen et al, 2020) 2) “Rural and remote Indigenous people who have CKD may have advanced disease and be unwell when they need to make a treatment decision, or they may further delay decision making, which can result in poor health outcomes and decreased quality of life” (Jansen et al, 2020).

• Less likely to receive a transplant (Canadian Institute for Health Information, 2013)

• Can be dependent on either Hemodialysis or Peritoneal dialysis (Canadian Institute for Health Information, 2013)

• Lower survival rates for the first five years following initial dialysis treatments: First year is 81.6% survival rate for Indigenous versus 84.3% survival rate for the average population (Canadian Institute for Health Information, 2013); "By the fifth year 39.6% versus 45.4%” (Canadian Institute for Health Information, 2013)

How do we address chronic kidney disease within the Indigenous population and include them in health care decisions?

• Develop educational material with needs in mind for this population; “Indigenous culture, traditional and Western health knowledge, and relational learning through working relationships and community engagement”; this inclusion of traditional knowledge fosters a partnership with the Indigenous population (Jansen et al, 2020).

• “Providing cultural safety training to health practitioners may increase their understanding of broader cultural factors, cultural safety and barriers that influence the patient–provider relationship” (Canadian Institute for Health Information, 2013)

• Establish clinics that allow patients to remain in their home community; this increases the support to their social network for support (Canadian Institute for Health Information, 2013)

• Acknowledge the fact that “Western medical models, which view disease as arising from the body and its components, do not account for the physical, emotional, intellectual and spiritual elements of Aboriginal conceptions of life, health and well-being (Earle, 2013)

• From personal experience, I have noticed the role of having an Indigenous patient navigator has helped with my facility. This individual can help patient in understanding current diagnosis but also liaise with the medical team. This has been important in having traditional healing ceremonies such as a smudging ceremony to occur while these patients are admitted to the hospital. This role has also been beneficial in educating staff on services and resources available to this vulnerable population.

References

Canadian Institute for Health Information. (2013, February). End- Stage Renal Disease Among Aboriginal Peoples in Canada: Treatment and Outcomes. https://secure.cihi.ca/free_products/EndStageRenalDiseaseAiB-ENweb.pdf.

Earle, L. (2013). Understanding chronic disease and the role for traditional approaches in aboriginal communities. https://www.ccnsa-nccah.ca/docs/emerging/FS-UnderstandingChronicDisease-Earle-EN.pdf.

Jansen, L., Maina, G., Horsburgh, B., Kumaran, M., Mcharo, K., Laliberte, G., Kappel, J., & Bullin, C. A. (2020). Co-Developed Indigenous Educational Materials for Chronic Kidney Disease: A Scoping Review. Canadian Journal of Kidney Health and Disease. https://doi.org/10.1177/2054358120916394

Levin, A., Adams, E., Barrett, B. J., Beanlands, H., Burns, K. D., Chiu, H. H., Chong, K., Dart, A., Ferera, J., Fernandez, N., Fowler, E., Garg, A. X., Gilbert, R., Harris, H., Harvey, R., Hemmelgarn, B., James, M., Johnson, J., Kappel, J., Komenda, P., … Manns, B. (2018). Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD): Form and Function. Canadian journal of kidney health and disease, 5, 2054358117749530. https://doi.org/10.1177/2054358117749530