INTEGRATED, COMMUNITY-LED, CULTURALLY SAFE IMPLEMENTATION OF A CHRONIC KIDNEY DISEASE DETECTION PROGRAM FOR INDIGENOUS COMMUNITIES OF CANADA: THE KIDNEY CHECK PROGRAM REPORT

Indigenous Peoples in Canada experience a disproportionate burden of chronic kidney disease (CKD) but continue to face systemic, geographic, and cultural barriers to early detection and care. This is more challenging for remote and underserved regions, where CKD risk is amplified by diabetes, hypertension, and the enduring effects of colonization. Kidney Check (early detection and management program) originated as a community-based screening initiative in Manitoba and, following early success, was integrated into the Can-SOLVE CKD Network to enable Indigenous leadership, national coordination, and cross-provincial scale-up. Grounded in Indigenous governance, data sovereignty, and partnership, the program promotes early detection of CKD and related risk factors through community-led, culturally grounded, and integrated approaches that advance health equity and reconciliation in practice.

Between April 2023 and March 2024, Kidney Check was implemented across three Can-SOLVE provinces—Alberta, British Columbia, and Manitoba—using a standardized point-of-care testing (POCT) protocol to assess serum creatinine, urine albumin-to-creatinine ratio, hemoglobin A1c, and blood pressure. Provincial teams co-developed screening and follow-up models with Indigenous partners, embedding local leadership while maintaining national data and quality standards. Two additional provinces, Ontario and Saskatchewan, implemented aligned but independently funded initiatives that adopted the same community-driven framework, clinical protocols, and data architecture. Screening was conducted in community venues by locally trained staff, supported by regional renal programs. Quantitative outcomes included participation, detection rates, and referrals; qualitative findings assessed feasibility, cultural safety, and sustainability.

More than 2,500 Indigenous adults from over 50 communities were screened. Alberta and British Columbia achieved full program scale-up, training more than 30 community health providers and screening over 700 participants in BC alone. Manitoba screened about 700 participants across 10 communities, identifying 22% at moderate-to-high CKD risk. Ontario resumed screening in 2024 across five regional renal programs, reaching 250 participants, while Saskatchewan launched its first events in 2023, screening 230 participants—28% requiring clinical follow-up. Overall, one in four participants had previously undiagnosed CKD or related risk factors. Qualitative findings emphasized trust, community ownership, and culturally anchored education as key drivers of engagement. Facilitators included Indigenous leadership, local workforce participation, and primary care integration, while challenges involved logistics, equipment maintenance, and staffing continuity.

Evolving from a Manitoba-based proof-of-concept to a national Can-SOLVE CKD initiative, Kidney Check demonstrates that community-led, culturally safe screening can bridge persistent gaps in early detection and prevention among Indigenous Peoples. Embedding screening within local systems and factoring Indigenous governance and data sovereignty provides a scalable, sustainable model for equitable kidney health promotion. The aligned Ontario and Saskatchewan initiatives confirm the adaptability of this framework beyond the Can-SOLVE structure. Kidney Check represents reconciliation in action—building trust, capacity, and partnership while redefining kidney health equity across Canada.