Where we fail; First Nations starting dialysis with inadequate nephrology referral time: an IKHealth (improving responsiveness across the continuum of kidney health care in rural and remote Manitoba First Nation communities) substudy.

objectiveEnd-stage kidney disease continues to disproportionally impact the lives of First Nations(FN) peoples. This paper examines the trajectory of chronic kidney disease (CKD) care in FN individuals who started dialysis.

methodsWe used health administrative data held at the Manitoba Centre for Health Policy (MCHP) for the period of 2000-2019, which was linked to the Manitoba First Nations Research File to identify Registered FN. Data we used included: Diagnostic Services Manitoba Laboratory Data, Medical Claims, Hospital Discharge Abstracts, Drug Program Information Network Data, Public Canadian Census Files, Manitoba Health Insurance Registry, and Physician Resource File. All records are de-identified. Our primary outcome was to assess the frequency of uninformed dialysis starts among FN. LESSONS LEARNED: We identified 1,686 FN people who started dialysis during the study period. Of those, 396 (23.5%) started dialysis within three months of their first nephrology visit. We compared those initiating dialysis within 3 month to other FN with longer nephrology follow-up: as a group, FN initiating dialysis within 3 month of their first nephrology visit were more unwell as evidenced by a significantly higher Elixhauser co-morbidity index (5 vs. 3 P < 0.001), hypertension (70.7% vs. 57.1% p < 0.001) and congestive heart failure (31.1 vs17.4% P < 0.001). Primary care visits in all FN groups with CKD occurred in over 95% and CKD screening was similar in all groups at over 40% a year prior to the first nephrology visit. Less than 70% of FN with CKD were on appropriate preventative medications (69 vs. 68% p = NS)) IMPLICATIONS: Improvements in primary prevention at the primary care level are needed to avoid late nephrology referrals and improve overall care of FN with CKD.