Over 90 per cent of patients with chronic kidney disease (CKD) are managed in primary care settings. In this week’s Innovator Spotlight, Aminu K Bello, a consultant nephrologist and professor in the Department of Medicine, discusses his work toward improving kidney care delivery and kidney disease prevention, including partnering with primary care teams to help deliver high-quality care for people living with kidney disease.
How do you describe your work to people who don’t work in your field?
The central themes of my research are global kidney health, rural/remote and Indigenous kidney health and investigating novel risk markers for adverse outcomes among individuals living with chronic kidney disease (CKD). I am particularly interested in the study and design of programs to facilitate optimal CKD care delivery among disadvantaged populations with limited resources, remote/rural dwellers and Indigenous populations, the primary focus of my research over the last decade. I am passionate about equitable kidney care delivery and kidney disease prevention in our Indigenous communities. Growing up in Nigeria, I saw first-hand many healthcare challenges, including limited access to care for patients with kidney disease. Many parts of the world face similar challenges, including Canada.
During my medical and research training, I developed a passion for researching to find solutions – especially in closing the gaps in healthcare access for disadvantaged population groups in different parts of the world. My passion led me to this incredible country. From a healthcare perspective, Canada has a unique challenge. This country has a vast geographic area with a small population. The majority of hospitals and treatment centers are located in cities in the south, leaving thousands of rural and remote communities with limited health services.
Putting my training and research experience into practice, I joined the patient-oriented research network Can-SOLVE CKD as the lead scientist of the Kidney Check program. This program addresses the gaps in access for Indigenous patients with kidney disease who live outside of large urban centres. In 2015, I was fortunate to have been invited by the International Society of Nephrology (ISN) to chair the development of the Global Kidney Health Atlas (GKHA) project. The ISN-GKHA is a multinational project conducted by the ISN to assess the current capacity for kidney care. The aim was to collect and document information on the status of existing resources, structures and organizations available globally to kidney disease patients. The first report published in 2017 revealed that kidney disease is a silent, global epidemic with a lack of infrastructure to support treatment and prevention. This global work drew attention to the growing burden of kidney failure and significant inequities in access to treatment across countries and regions.
In Canada, a major contribution that we have made involves translating clinical research into practice and facilitating understanding of clinical practice guidelines. In primary care, we noticed the lack of an effective mechanism to monitor the uptake of kidney care guidelines where over 90 per cent of patients with CKD are managed. To address this problem, we partnered with the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) to establish a CKD primary care monitoring system. The CPCSSN is the first pan-Canadian multi-disease surveillance system that collects health information from electronic medical records across primary care practices nationwide. We were instrumental in getting CKD included in the list of conditions for surveillance. We built a national collaborative team of experts in primary care, nephrology and public health to define the process of care for CKD based on established quality indicators and investigated care variation across patient and provider characteristics as well as regional characteristics across Canada. We leveraged international collaborations with existing platforms such as the United States Centers for Disease Control and Prevention Chronic Kidney Disease (US CDC CKD) Surveillance and national networks such as the Canadian Society of Nephrology to ensure our findings are translated into practice. The goal is to use it to develop a national CKD surveillance system similar to other developed countries such as Australia, the United Kingdom and the United States.
What’s one big problem you want to solve through your work?
The major problems we aim to solve are the healthcare disparities being faced by our remote and Indigenous communities in Canada, and the significant inequities regarding access to and quality of kidney care around the world, which are most pertinent in low-income countries. We are working towards solutions, and this is our focus for research, innovation and capacity building. To cite an example, the likelihood of development of kidney failure among Indigenous people is three times higher compared to the general population in Canada.
These are serious challenges that need concerted efforts toward solutions. The solutions are simple and only need basic elements of care delivery, not sophisticated technologies. If we diagnose chronic kidney disease early using basic technology in such communities and apply early treatment, a number of people will be prevented from getting to the stage of kidney failure requiring dialysis or transplant. These people can remain in their communities accessing care without the need to move to bigger centres to access dialysis or kidney transplants.
One of the most rewarding things about our work is the team approach. We work closely with Indigenous communities on tailoring and implementing the program in their communities and shaping it to incorporate their unique needs and culture. The key goal is to reduce the risk of patients developing chronic kidney disease. By reducing the risk, these patients won’t have to leave everything they know and love, their home and family, their culture, to move to an urban area with access to treatments like dialysis. We are working in a similar vein with the International Society of Nephrology (ISN) and relevant stakeholders to close the gaps in the global inequities in kidney care around the world.
What does the word “innovation” mean to you?
In a few words, innovation to me is development or bringing up new ways of doing things to impact the world positively. In my small area of work, this would mean finding novel pathways for preventing kidney disease and the havoc it causes people across the world, so that we may one day have a world completely devoid of kidney diseases and associated risk factors. This is our vision and strategic focus for the future.
What’s been your biggest a-ha moment — in life or work — so far?
Being welcomed with open arms to this great country and given all the opportunities to pursue my dreams in an environment that values quality in healthcare delivery and promotes scholarship and innovation. This enables enormous satisfaction of seeing our work impacting the lives of others in Canada and several parts of the world.
How do you or your team come up with your best ideas?
It is really about the people I meet and work with every day in different areas including research and teaching environments. In the clinical areas, I feel great every day working with such humane individuals helping our patients living with kidney diseases in an environment that values respect, compassion and quality.
In Shape: The University Strategic Plan 2023-2033, the University of Alberta commits to having a positive impact on our students and staff, our communities, and the communities we serve here in Alberta and around the world. What are the impacts of your work?
Our work has had a significant impact on communities here in Canada and internationally. We have led policy-relevant works on improving access to kidney care around the world. We have produced policy reports and briefs through our work with the International Society of Nephrology to help national and international nephrology societies inform governments and stakeholder organizations about the growing burden of kidney disease and best practices for CKD prevention and treatment. These reports have helped with the development of global kidney care surveillance networks and mechanisms of accountability for closing the gap in kidney care, particularly among the world’s most disadvantaged population groups, living in low-resource settings.
What’s next for you? Do you have any new projects on the horizon?
Our goal is to continue to build on this foundation, ensuring that we maintain the current international collaborations and provide continued leadership in global kidney health, care delivery innovations, building primary care capacity and developing effective global policies for optimal CKD care in Canada and beyond. We have identified key gaps in kidney care around the world, and are now focused on developing solutions. At the national level, we are actively engaging with some national initiatives such as Can-SOLVE, and internationally with the ISN and related organizations towards achieving such goals.
