Grant: Project Grant

Manitoba First Nations (MFNs) have the highest documented prevalence and the second highest incidence of end-stage kidney disease (ESKD) in Canada. Those living in rural/remote locations and requiring care experience significant barriers. Although preventable, nephrologists heard FN patients, especially from "renal families" (where other members have chronic kidney disease, CKD/ESKD), report that ESKD is inevitable. These statements likely reflect limited opportunities for maintaining health in the face of barriers including racism, perpetuating risk factors and undermining prevention efforts. This partnership-based program of research brings together community-based researchers from the Nanaandawewigamig Diabetes Integration Program (hereafter DIP, a part of the Assembly of Manitoba Chiefs), FN patients with lived experience of renal disease, University of Manitoba (UM) university-based researchers and members of the MRP (nephrologists, nurses, dietitian, social worker). We propose a 5 year program of research with 2 broad objectives: 1. To improve access to effective PC-based care for patients identified at being at low and medium risk of CKD; and 2. To expand the number of dialysis modalities available to FNs through the development of a FN-centric assisted PD model (APD), developed in partnership with FN communities. ESKD/CKD continues to fundamentally impact the lives of Indigenous patients, their families and communities. Despite repeated reviews and the implementation of a range of renal service plans, access to dialysis (in varied forms) in Manitoba rural and remote communities, including MFN communities, remains poor and still results in family dislocation. The critical questions outlined in this application remain unanswered, and stand to make a significant impact on primary care, treatment options and outcomes.