Indigenous Health: Receiving Care Away from Home with Focus on ESRD

Question 1

Compare the frequency of ESRD among Indigenous and non-Indigenous adults

Answer 1

Indigenous adults are 3 times more likely to be new patients with ESRD than non-Indigenous.
They are also 3 times more likely to be receiving treatment for ESRD.

Question 2

Two main risk factors for ESRD (esp. in Indigenous adults)

Answer 2

diabetes and obesity

(both of these conditions are more prevalent among Indigenous adults compared to non-Indigenous)

Question 3

Indigenous ESRD median age vs non-Indigenous

Answer 3

Indigenous: 54
Non: 62

Question 4

For both Indigenous and non-Indigenous people, ESRD is more common in men or women?

Answer 4

More common in men than in women

Question 5

What are the 2 main causes of ESRD in children and youth (<22) ?

Answer 5

Glomerulonephritis
Congenital malformation

Question 6

Are congenital disease rates higher in Indigenous or non-Indigenous youth?

Answer 6

Less rates of congenital diseases found in Indigenous youth.

Question 7

For young adults, what is the primary cause of ESRD?

Answer 7

Glomerulonephritis (not diabetes)

Question 8

Distances travelled to receive treatment for ESRD for Indigenous vs non-Indigenous adults

Answer 8

Indigenous people had to travel 4 times farther to receive care (20% vs 5% had to travel for care)

Question 9

Treatment options for ESRD (3)

Answer 9

Medical management
Dialysis
Kidney transplantation

Question 10

What type of treatment do most Indigenous patients receive (for ESRD)?

Answer 10

Hemodialysis
(less likely to receive peritoneal dialysis i.e. less likely to be treated at home)

Those Indigenous patients who do start PD are more likely to have a technique failure and require a switch to hemodialysis

Question 11

How do kidney transplantation rates compare for Indigenous vs. non-Indigenous patients?

Answer 11

Indigenous ESRD patients are 50% less likely to receive a kidney transplantation

Question 12

Following initiation of dialysis, how do the 5-year survival rates compare for Indigenous vs. non-Indigenous patients?

Answer 12

Indigenous patients have lower survival rates in the period after starting dialysis

Question 13

Following transplantation, how do the the 5-year graft survival rates compare between Indigenous and non-Indigenous patients?

Answer 13

Survival rates are similar for both

Question 14

Children and transplant (key facts and comparisons)

Answer 14

• The time from starting dialysis to receiving a transplant is longer for Indigenous children
• Indigenous children are less likely to receive a transplant (both from living and deceased donor)

Question 15

Reasons why Indigenous patients are less likely to receive kidney transplants (3)

Answer 15

1. DIABETES (age of onset is much younger for Indigenous patients and more likely to have complications, making them less eligible for receiving or giving a kidney)
2. LANGUAGE & CULTURAL BARRIERS (lack of understanding, mistrust)
3. CULTURAL DIFFERENCES ON TRANSPLANTATION (not common)

Question 16

True or false: Distance to treatment is a barrier to transplantation for both Indigenous adults and children.

Answer 16

False! Distance from treatment centre was not found to be a barrier to transplantation for adults, but DOES seem to be a factor for children!

Question 17

What is the main health condition that must be addressed for prevention of ESRD in Indigenous patients?

Answer 17

Type II diabetes prevention (since onset age is so much younger in Indigenous nations)

Question 18

Main ESRD risk factors in Indigenous people (2)

Answer 18

Diabetes and obesity

Question 19

Jordan’s principle

Answer 19

Jordan was a Cree child from Manitoba. He had complex medical history and was in hospital for many years until he was allowed to return home to his community - however, the provincial & federal government could not agree on who would cover the travel costs and Jordan passed away in hospital age 5 before the case was settled.

Question 20

What is the role of healthcare providers in combatting the challenges faced by Indigenous patients

Answer 20

Be prepared to fight for your patients! Advocate strongly to change policies, receive additional funding, etc.

Question 21

Why is it difficult for some Indigenous communities to adhere to the recommended diet?

Answer 21

It is difficult/expensive to obtain low-salt, low-fat food options in the community

Question 22

Main difficulties in receiving care away from home (8)

Answer 22

1. Increased expenses
2. Housing inadequacies
3. Family separation
4. Lack of control over health
5. Loss of freedom
6. Inability to contribute to community
7. Uncertainty of future
8. Depression

Question 23

What are some practices that help make care away from home easier for Indigenous patients? (2)

Answer 23

• Cultural liaison services (interpreters)
• Social services (be aware that patients may be suspicious of social workers)

Question 24

How can physicians advocate for their Indigenous patients?

Answer 24

• If needed, ask for an escort or a second escort (ideally family member)
• Advocate for more funding
• Help family mitigate red tape (bureaucracy)
• Advocate for better national policies & exceptions

Question 25

Overall, what are 2 ideal solutions to reduce the necessity of care away from home for Indigenous peoples?

Answer 25

1. Educating more Indigenous health care providers
2. Offering more health care services in Indigenous communities

Question 26

Conclusions (Review Card)

Answer 26

Indigenous peoples:
* 3 times more likely to have ESRD
* Younger than non-Indigenous patients with ESRD
* More likely to have to travel further for care
*Less likely to receive a kidney transplant
* Lower survival rates in the period after starting dialysis
* Similar survival rates post-transplant