OBJECTIVE: To determine if a community-based multifactorial intervention clinic led by a nurse practitioner would improve management of First Nations people at risk of developing chronic kidney disease. DESIGN: Qualitative descriptive study. SETTING: A nephropathy-prevention clinic in Siksika Nation, Alta. PARTICIPANTS: First Nations people with diabetes, hypertension, or dyslipidemia who were referred to the clinic. MAIN OUTCOME MEASURES: Changes in blood pressure (BP), hemoglobin A(1c), and low-density lipoprotein levels, as well as in use of antiplatelet therapy, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker medications, and statin therapy. RESULTS: Members of the Siksika Nation were treated according to clinical practice guidelines. A total of 78 patients had at least 2 visits to the clinic and were included in this analysis (61.5% were women; mean age 56 years). Among those initially above target, a significant reduction was achieved in mean hemoglobin A(1c) (0.96%; P < .01), systolic BP (15.84 mm Hg; P < .05), diastolic BP (7.16 mm Hg; P < .001), and low-density lipoprotein (0.62 mmol/L; P < .01) levels. There was a significant increase in the proportion of patients with clinical indications who were treated with acetylsalicylic acid (42.4%; P < .01), angiotensin-converting enzyme inhibitor or angiotensin receptor blocker medications (35.9%; P < .01), or statin therapy (35.9%; P < .01). CONCLUSION: A community-based, nurse practitioner-led clinic can improve many clinically relevant factors in patients at risk of developing chronic kidney disease. Studies have shown that achieving treatment targets is associated with a reduced risk of early death and cardiovascular events; the effect in the First Nations population on these hard clinical end points remains to be determined.
OBJECTIVE: To determine if a community-based multifactorial intervention clinic led by a nurse practitioner would improve management of First Nations people at risk of developing chronic kidney disease. DESIGN: Qualitative descriptive study. SETTING: A nephropathy-prevention clinic in Siksika Nation, Alta. PARTICIPANTS: First Nations people with diabetes, hypertension, or dyslipidemia who were referred to the clinic. MAIN OUTCOME MEASURES: Changes in blood pressure (BP), hemoglobin A(1c), and low-density lipoprotein levels, as well as in use of antiplatelet therapy, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker medications, and statin therapy. RESULTS: Members of the Siksika Nation were treated according to clinical practice guidelines. A total of 78 patients had at least 2 visits to the clinic and were included in this analysis (61.5% were women; mean age 56 years). Among those initially above target, a significant reduction was achieved in mean hemoglobin A(1c) (0.96%; P < .01), systolic BP (15.84 mm Hg; P < .05), diastolic BP (7.16 mm Hg; P < .001), and low-density lipoprotein (0.62 mmol/L; P < .01) levels. There was a significant increase in the proportion of patients with clinical indications who were treated with acetylsalicylic acid (42.4%; P < .01), angiotensin-converting enzyme inhibitor or angiotensin receptor blocker medications (35.9%; P < .01), or statin therapy (35.9%; P < .01). CONCLUSION: A community-based, nurse practitioner-led clinic can improve many clinically relevant factors in patients at risk of developing chronic kidney disease. Studies have shown that achieving treatment targets is associated with a reduced risk of early death and cardiovascular events; the effect in the First Nations population on these hard clinical end points remains to be determined.
Authors: B R Hemmelgarn; Finlay A McAlister; Steven Grover; Martin G Myers; Donald W McKay; Peter Bolli; Carl Abbott; Ernesto L Schiffrin; George Honos; Ellen Burgess; Karen Mann; Thomas Wilson; Brian Penner; Guy Tremblay; Alain Milot; Arun Chockalingam; Rhian M Touyz; Sheldon W Tobe Journal: Can J Cardiol Date: 2006-05-15 Impact factor: 5.223
Authors: Song Gao; Braden J Manns; Bruce F Culleton; Marcello Tonelli; Hude Quan; Lynden Crowshoe; William A Ghali; Lawrence W Svenson; Brenda R Hemmelgarn Journal: J Am Soc Nephrol Date: 2007-10-17 Impact factor: 10.121
Authors: Sheldon W Tobe; George Pylypchuk; Joan Wentworth; Alexander Kiss; John Paul Szalai; Nancy Perkins; Susan Hartman; Laurie Ironstand; Jacqueline Hoppe Journal: CMAJ Date: 2006-04-04 Impact factor: 8.262
Authors: Peter Gaede; Pernille Vedel; Nicolai Larsen; Gunnar V H Jensen; Hans-Henrik Parving; Oluf Pedersen Journal: N Engl J Med Date: 2003-01-30 Impact factor: 91.245
Authors: Sophia H Chou; Marcello Tonelli; John S Bradley; Sita Gourishankar; Brenda R Hemmelgarn Journal: Clin J Am Soc Nephrol Date: 2005-11-09 Impact factor: 8.237
Authors: Robert G Weaver; Braden J Manns; Marcello Tonelli; Claudia Sanmartin; David J T Campbell; Paul E Ronksley; Richard Lewanczuk; Ted C Braun; Deirdre Hennessy; Brenda R Hemmelgarn Journal: CMAJ Open Date: 2014-03-07