Equity-focused study on immigrant kidney disease risk

HN Summary

• A new SHN-led study published in BMJ Open reveals significant disparities in chronic kidney disease risk among Scarborough’s immigrant communities, using local population data to better understand who is most affected.

• The research found country of birth to be a stronger predictor of dialysis risk than ethnicity alone, with immigrants from the Caribbean, the Philippines, and Sri Lanka facing six to twelve times higher risk than Canadian-born residents.

• These findings are laying the groundwork for more targeted, equity-focused kidney disease screening and prevention, helping SHN move from identifying disparities to designing earlier, more effective interventions.

Scarborough Health Network (SHN) is leading health equity-focused research through the work of Dr. Tabo Sikaneta, SHN nephrologist and lead investigator on a newly published study, which examines the disparities in chronic kidney disease among Scarborough residents. The study was designed to test a long-standing observation: that certain immigrant and ethnic groups appeared to disproportionately represent patients with kidney failure. Dr. Sikaneta set out to examine this using local population data. Published in the research journal BMJ Open, the study marks an important step toward rethinking how kidney disease risk is identified, monitored, and addressed in one of Canada’s most diverse communities.

SHN’s Regional Nephrology Program, the largest of its kind in Ontario, provides care to thousands of patients each year across the full spectrum of kidney disease. Combined with Scarborough’s diverse population, where nearly 60 per cent of residents are immigrants and 75 per cent belong to visible minority groups, SHN clinicians are uniquely positioned to identify opportunities to improve kidney care in a diverse population.

While the study provides important new evidence about who is most at risk, its greatest impact may lie in what comes next: Dr. Sikaneta’s work is helping lay the foundation for more effective screening, intervention, and care models for immigrant communities, both in Scarborough and beyond. By identifying risk in patients earlier, the study findings highlight opportunities for earlier action that might reduce the number of patients that progress to end-stage kidney disease.

From evidence to action

The inspiration behind the study came from Dr. Sikaneta’s routine patient dialysis rounds.

“What I was seeing on the dialysis units didn’t feel random,” he shared. “I wanted to formally understand who was making up this increased kidney disease, and whether there were patterns in specific population groups that we weren’t addressing early enough. Answering that question required examining local data.”

Dr. Sikaneta initiated this research in 2018, analyzing dialysis patients who were verified Scarborough residents. By focusing specifically on the local population, the study offered insights that are directly relevant to the community SHN serves. He found that country of birth was a stronger predictor of dialysis risk than ethnicity alone. Immigrants from the Caribbean, the Philippines, and Sri Lanka were six to twelve times more likely to receive dialysis than Canadian-born residents, putting them at a particularly high risk of end-stage kidney disease. These findings also confirmed an elevated health risk seen in Ontario’s Black population, and added new, Scarborough-specific clarity about other at-risk ethnic groups.

Importantly, the study found that time since immigration did not reduce kidney disease risk. Whether individuals had lived in Canada for three years or three decades, their elevated risk persisted, which Dr. Sikaneta said showed that risk doesn’t necessarily diminish over time, reinforcing the need for proactive screening strategies for certain groups.

“Based on these results, we can start to think toward solutions, including the redesign of kidney disease screening processes to be more targeted and effective,” Dr. Sikaneta shared. 

He explained that rather than applying uniform screening models, kidney disease detection can be tailored to populations shown to be at higher risk. Similar to established models in other areas of care, such as breast cancer screening, where individuals at higher risk are identified earlier and monitored more closely.

“We could set an example with earlier screening right here in Scarborough, where there is a significant presence of kidney disease in these ethnic groups.”

He also explained that the study highlighted how health care resources could be distributed more effectively. End-stage kidney disease requiring dialysis affects a relatively small number of patients, yet requires many resources. By focusing attention on groups at highest risk, targeted interventions can improve outcomes while benefitting the broader system.

“Dr. Sikaneta’s study reflects SHN’s broader commitment to using local data to inform smarter, more equitable care models that can be scaled and adapted to other regions,” shared Dr. Samir Grover, Executive Vice President of Academics at SHN. “This leading investigative work helps us, and other professionals, move from identifying disparities to designing solutions that improve care for the communities we serve.”

Dr. Sikaneta also emphasized that these findings should not be used to stigmatize immigrant communities, but rather to ensure they receive equitable, timely care. As SHN continues to invest in clinician-led research, studies like this are helping shape the future of healthcare delivery, ensuring that care is not only high quality, but also responsive to the lived realities of Scarborough’s population.