Integrated, Community-Led, Culturally Safe Implementation of a Chronic Kidney Disease Detection Program for...

Indigenous peoples in Canada experience a disproportionate burden of chronic kidney disease (CKD) yet face systemic, geographic, and cultural barriers to early detection and care. The Kidney Check program was established as a national initiative to address this gap by providing community-led, culturally safe, and integrated chronic disease screening.

Kidney Check builds on the success of the First Nations Community-Based Screening to Improve Kidney Health and Prevent Dialysis (FINISHED) study in Manitoba and was expanded through the Can-SOLVE CKD Network. This report summarizes updated data from April 2023 to March 2024, capturing the implementation of Kidney Check across five provinces: Alberta (AB), British Columbia (BC), Manitoba (MB), Ontario (ON), and Saskatchewan (SK). Data sources include provincial program records, training logs, process measures, referral data, patient and provider testimonials, and qualitative evaluations from community members, providers, and patient partners.

Kidney Check applies a standardized, mobile, point-of-care-testing (POCT)-based screening protocol for CKD, diabetes, and hypertension, adapted locally in collaboration with Indigenous communities. Implementation followed principles of Indigenous governance, data sovereignty (Ownership, Control, Access, Possession [OCAP]), and Two-Eyed Seeing, where both Western and Indigenous medicines and ways are acknowledged, respected, and practiced, with provincial adaptations tailored to local contexts. Information was synthesized across jurisdictions to identify process measures, barriers and facilitators to implementation, and early outcomes.

Since program inception, thousands of Indigenous participants have been screened across more than 50 communities. AB and BC demonstrated scale-up through train-the-trainer and community-embedded models, training over 30 providers and screening >700 participants in BC alone. Manitoba built on the FINISHED study to deliver screening in 10 communities, with nearly 700 participants screened. Ontario resumed screening in 2024, with >250 participants screened across five regional renal programs. Saskatchewan launched Kidney Check in 2023, screening 230 participants, with early identification of intermediate- and high-risk individuals. Across sites, facilitators included strong community partnerships, local hiring, and integration with existing health services. Barriers included logistical challenges (equipment, travel, quality assurance and quality control [QA/QC]), staffing constraints, and sustainability concerns.

Variation in infrastructure, referral pathways, and data systems across provinces limits cross-jurisdictional comparability. Long-term outcome data (eg, CKD progression, cardiovascular events, mortality) are not yet available.

The Kidney Check program demonstrates that culturally safe, community-led, POCT-based screening for CKD and related chronic diseases is feasible, acceptable, and scalable across diverse Indigenous communities in Canada. Lessons learned highlight the central importance of Indigenous leadership, cultural safety, and flexible delivery models to advance health equity.