Dataset Information

Remote Dwelling Location Is a Risk Factor for CKD Among Indigenous Canadians.

ABSTRACT: Rural and remote indigenous individuals have a high burden of chronic kidney disease (CKD) when compared to the general population. However, it has not been previously explored how these rates compare to urban-dwelling indigenous populations.In a recent cross-sectional screening study, 1346 adults 18 to 80 years of age were screened for CKD and diabetes across 11 communities in rural and remote areas in Manitoba, Canada, as part of the First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis (FINISHED) program. An additional 284 Indigenous adults who resided in low-income areas in the city of Winnipeg, Manitoba, Canada were screened as part of the NorWest Mobile Diabetes and Kidney Disease Screening and Intervention Project.Our findings indicate that a gradient of CKD and diabetes prevalence exists for Indigenous individuals living in different geographic areas. Compared to urban-dwelling Indigenous individuals, rural-dwelling individuals had more than a 2-fold (2.1, 95% CI = 1.4-3.1) increase in diabetes whereas remote-dwelling individuals had a 4-fold (4.1, 95% CI = 2.8-6.0) increase, and more than a 3-fold (3.1, 95% CI = 2.2-4.5) increase in CKD prevalence.Although these results highlight the relative importance of geography in determining the prevalence of diabetes and CKD in Indigenous Canadians, geography is but an important surrogate of other determinants, such as poverty and access to care.

SUBMITTER: Harasemiw O

PROVIDER: S-EPMC6035135 | biostudies-other | 2018 Jul

REPOSITORIES: biostudies-other

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Remote Dwelling Location Is a Risk Factor for CKD Among Indigenous Canadians.

Harasemiw Oksana O Milks Shannon S Oakley Louise L Lavallee Barry B Chartrand Caroline C McLeod Lorraine L Di Nella Michelle M Rigatto Claudio C Tangri Navdeep N Ferguson Thomas T Komenda Paul P

Kidney international reports 20180210 4

<h4>Introduction</h4>Rural and remote indigenous individuals have a high burden of chronic kidney disease (CKD) when compared to the general population. However, it has not been previously explored how these rates compare to urban-dwelling indigenous populations.<h4>Methods</h4>In a recent cross-sectional screening study, 1346 adults 18 to 80 years of age were screened for CKD and diabetes across 11 communities in rural and remote areas in Manitoba, Canada, as part of the First Nations Community ...[more]

PMID: 29989009

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Project description:Rationale & objectiveRecent literature suggests improvement in kidney function after percutaneous valvular replacement therapies, implying a pathophysiological contribution of valvular heart disease to chronic kidney disease (CKD). However, this association has not been investigated epidemiologically. We aimed to assess the association of valvular abnormality with prevalent and incident CKD.Study designCross-sectional and prospective analyses.Setting & participantsCommunity-dwelling participants (mean age 75.5 [standard deviation 5.1] years) from the Atherosclerosis Risk in Communities study (2011-2013).ExposureValvular abnormality defined as echocardiography-based aortic stenosis, aortic regurgitation, and mitral regurgitation.OutcomesPrevalent CKD was defined as estimated glomerular filtration rate (eGFR]) <60 mL/min/1.73 m2. Incident CKD was defined as progression to eGFR <60 mL/min/1.73 m2 with ≥25% decline or hospitalization/deaths with CKD diagnosis.Analytical approachWe cross-sectionally evaluated the association between valvular abnormality and prevalent CKD with logistic regression in 5,216 participants. Then, 3,752 participants without prevalent CKD were analyzed for incident CKD using Cox models.ResultsThere were 1.4% (n = 74) with any aortic stenosis, 10.6% (n = 555) with any aortic regurgitation, and 43.1% (n = 2,249) with any mitral regurgitation. After adjustment for potential confounders, any mitral regurgitation and moderate/severe aortic regurgitation showed significant associations with prevalent CKD (adjusted OR, 1.17 [95% CI, 1.03-1.34] and 2.82 [95% CI, 1.12-7.10]), as did any aortic stenosis in a sensitivity analysis with prevalent CKD defined including albuminuria ≥30 mg/g (1.83 [95% CI, 1.10-3.05]). Only any aortic stenosis showed an independent association with incident CKD (adjusted HR, 2.12 [95% CI, 1.13-4.00]).LimitationsDespite a relatively large study population, some subgroups had small numbers. Although we minimized reverse causation, we cannot completely rule it out.ConclusionsDifferent valvular abnormality types were associated with prevalent CKD. Only aortic stenosis was robustly associated with incident CKD. These findings suggest an etiological link between valvular abnormality and CKD, highlighting the importance of clinical attention to kidney function in individuals with aortic stenosis.

Dataset Information

Remote Dwelling Location Is a Risk Factor for CKD Among Indigenous Canadians.

Publications

Remote Dwelling Location Is a Risk Factor for CKD Among Indigenous Canadians.

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