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Indigenous peoples often endure significant health disparities fueled by historic and ongoing marginalizing policies and practices. In many cases, Indigenous groups are isolated from mainstream health care services (geographically, economically, or culturally) and lack the preventive health benefits associated with continuity of care.1 In Canada, this manifests in disproportionately high rates of chronic disease, often diagnosed at a younger age and greater severity than non-Indigenous groups. Of these, chronic kidney disease (CKD), diabetes, and hypertension are highly prevalent, reaching epidemic levels in many communities.2 Kidney Check is a comprehensive screen, triage, and treat initiative working to bring preventive kidney care to rural and remote Indigenous communities across Manitoba, Ontario, British Columbia, Alberta, and Saskatchewan. Modeled after the 2015 FINISHED initiative in Manitoba,3 and working within the CanSOLVE CKD network (www.cansolveckd.ca/), Kidney Check employs point-of-care testing (POCT) to identify CKD, diabetes, and hypertension in individuals aged 10 and up regardless of preexisting risk factors. To ensure the efficacy and sustainability of the program, Kidney Check relies on a strategic quality management system that addresses all aspects of the screening process. The intent of this manuscript is to describe the development process of all procedures and components related to the deployment of the Kidney Check program with specific focus on organizational structure, point-of-care testing devices, and data management. The Kidney Check Team Kidney Check’s management structure consists of the leadership team, advisory committee, patient partner committee, and mobile screening teams. Leadership provides guidance to the provincial teams to ensure the appropriate objectives, processes, and tools are in place to support high-functioning groups. This includes working closely with the advisory committee to preemptively identify potential barriers and risk issues in order to develop efficient mitigation strategies. Largely composed of Indigenous stakeholders and closely affiliated with the CanSOLVE CKD Indigenous People’s Engagement Council (IPERC), the advisory committee provides valuable insight on how to best use engagement strategies to maximize participation in the screening event. They are supported by the patient partner committee that oversees the execution of knowledge translation activities including but not limited to community selection criteria, community engagement procedures, and review of communication materials and strategies. Screening teams operate under the auspices of the Diabetes Integration Project and First Nations Health and Social Secretariat of Manitoba (FNHSSM). Stationed in various communities across the country, the team’s primary aim is to accommodate high throughput while maintaining quality control (QC) standards. As an affiliate of the CanSOLVE CKD network, members of all committees within Kidney Check have linkages to the broader network.

Introduction: Rural and remote indigenous individuals have a high burden of chronic kidney disease (CKD) when compared to the general population. However, it has not been previously explored how these rates compare to urban-dwelling indigenous populations. Methods: In a recent cross-sectional screening study, 1346 adults 18 to 80 years of age were screened for CKD and diabetes across 11 communities in rural and remote areas in Manitoba, Canada, as part of the First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis (FINISHED) program. An additional 284 Indigenous adults who resided in low-income areas in the city of Winnipeg, Manitoba, Canada were screened as part of the NorWest Mobile Diabetes and Kidney Disease Screening and Intervention Project. Results: Our findings indicate that a gradient of CKD and diabetes prevalence exists for Indigenous individuals living in different geographic areas. Compared to urban-dwelling Indigenous individuals, rural-dwelling individuals had more than a 2-fold (2.1, 95% CI = 1.4−3.1) increase in diabetes whereas remote-dwelling individuals had a 4-fold (4.1, 95% CI = 2.8−6.0) increase, and more than a 3-fold (3.1, 95% CI = 2.2−4.5) increase in CKD prevalence. Conclusion: Although these results highlight the relative importance of geography in determining the prevalence of diabetes and CKD in Indigenous Canadians, geography is but an important surrogate of other determinants, such as poverty and access to care. Keywords: chronic kidney disease, Indigenous Canadians, remoteness, rurality, screening, social determinants of health