• Danielle M Nash, Jade S Dirk, Eric McArthur, Michael E Green, Baiju R Shah, Jennifer D Walker, Mary Beaucage, Carmen R Jones, and Amit X Garg.
• ICES Western (Nash, Dirk, McArthur, Garg); Department of Epidemiology and Biostatistics (Nash), Western University, London Ont.; ICES Central (Shah, Walker), Toronto, Ont.; Department of Infectious Diseases (Dirk), Nova Scotia Health Authority, Halifax, NS; ICES Queen's (Green); Department of Family Medicine (Green), Queen's University, Kingston, Ont.; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Patient and Family Advisory Council (Beaucage), Ontario Renal Network; the Chiefs of Ontario (Jones), Toronto, Ont.; Department of Medicine (Garg), Western University, London, Ont. Danielle.nash@ices.on.ca.
• CMAJ Open. 2019 Oct 1; 7 (4): E706-E712.

BackgroundEnd-stage kidney disease is a serious complication of diabetes. We describe the prevalence of chronic kidney disease, prevalence and incidence of end-stage kidney disease and quality of care of early-stage chronic kidney disease for First Nations people with diabetes compared to other Ontarians with diabetes.MethodsWe conducted a retrospective cohort study in Ontario using linked administrative data at ICES. We included adults with incident diabetes between 1994 and 2014, and used laboratory values to identify kidney disease and quality indicators for care for early-stage disease. We compared measures in First Nations people to those in other people in Ontario, and used direct age and sex standardization. We used Cox proportional hazards regression to compare the incidence of end-stage kidney disease between groups.ResultsOur study included 21 968 First Nations people with diabetes. The age- and sex-standardized prevalence of chronic kidney disease was higher for First Nations people than for other Ontarians (20.7% v. 18.4%), as was the prevalence of end-stage kidney disease (2.9% v. 1.0%). The incidence of end-stage kidney disease was higher among First Nations people than among other people in Ontario (9.3 v. 4.7 events per 10 000 person-years; age- and sex-adjusted hazard ratio 2.23, 95% confidence interval 1.72-2.89). The 2 groups were similarly likely to receive recommended medications, but First Nations people were less likely to receive laboratory tests for their kidney disease.InterpretationDespite receiving similar quality of care for early-stage kidney disease, First Nations people with diabetes had higher rates of end-stage kidney disease than other Ontarians. Further research is needed to better understand contributing factors to help inform future interventions.Copyright 2019, Joule Inc. or its licensors.

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