Tackling kidney disease
As a nurse working in outpost stations in northern Saskatchewan and the Northwest Territories, AHFMR Population Health Investigator Dr. Brenda Hemmelgarn saw the challenges of Aboriginal health at first hand. The experience sparked her interest in research. She went on to do Ph.D. and M.D. degrees and now works as a nephrologist (a doctor who treats people with kidney problems) and a researcher at the University of Calgary.
Her research focuses on kidney disease among Aboriginal people. While the prevalence of chronic kidney disease is essentially the same in both Aboriginal and non-Aboriginal populations, the Aboriginal population has a rate of kidney failure that is two to four times higher. This is very closely related to the high incidence of diabetes in the Aboriginal community. But even among Aboriginal people without diabetes, the rates of kidney failure are higher. “As a doctor, I want to know why. As a researcher, I’m particularly interested in what kinds of healthcare processes could be related to these inequities. What is it in the way we deliver care that may be contributing to the higher rates of kidney failure?”
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| Artwork: Aaron Paquette. Fire is Spirit (2008.084.001). Acrylic, oil, gold leaf on canvas. 91.5 x 61 cm. 2007. Collection of the Alberta Foundation for the Arts. |
Dr. Hemmelgarn’s team has found that Aboriginal people in Alberta are 43% less likely than other people to visit a nephrologist even if they have severe kidney disease. Another notable difference is in the management of kidney disease for people with conditions that if treated adequately in an outpatient setting should not result in hospitalization. The team found that Aboriginal people were twice as likely to be hospitalized for these conditions. This finding suggests that these cases of kidney disease are not being managed properly. “But we don’t know what aspect of care is not managed properly,” says Dr. Hemmelgarn.
Since publishing the data on the prevalence of chronic kidney disease, Dr. Hemmelgarn’s team has started looking at other aspects of care; how well diabetes is controlled, for example. “We’d also like to do some primary data collection to get at the patient-related factors such as access to care, patients’ perceptions, and any barriers they may be experiencing. There’s more we need to know.”
One of the findings of her research is already being followed up clinically—namely, the finding that Aboriginal people in rural locations are less likely to come to a city to see a nephrologist. A specialized clinic for individuals at high risk for kidney disease has been set up at the Siksika First Nation, 100 kilometres east of Calgary. People with diabetes and those who have blood pressure that is difficult to control see a nurse-practitioner once a week.