In Canada's increasingly diverse urban landscapes, chronic kidney disease (CKD)—a condition where the kidneys gradually lose their ability to filter waste from the blood—presents a growing public health challenge. A groundbreaking study led by Scarborough Health Network (SHN) nephrologist Dr. Tabo Sikaneta has shed light on stark disparities in kidney disease risk among immigrant communities in one of the country's most multicultural areas. Published in BMJ Open in December 2025, the research analyzed local data from Scarborough, Toronto, revealing that country of birth emerges as a more potent predictor of dialysis need than ethnicity alone. This finding underscores the need for tailored prevention strategies in Canada's universal healthcare system.

Scarborough, home to over 630,000 residents representing more than 100 ethnic origins, serves as a microcosm of Canada's evolving demographics. With immigrants comprising about 55% of its population, the area hosts Canada's largest regional dialysis program. The study, drawing from two cohorts—one retrospective of 1,116 dialysis patients from 2016-2019 and another prospective of 1,281 non-dialysis CKD patients followed from 2010-2015—highlights how environmental, genetic, and socioeconomic factors intersect to heighten risks for certain groups.

🩸 The Alarming Rise of CKD Across Canada

Chronic kidney disease affects roughly 1 in 10 Canadians, totaling around 4.5 million people as of 2024. Projections from the Kidney Foundation of Canada indicate this number could surpass 6.2 million by 2050, fueled by an aging population, surging diabetes rates, and hypertension. Mortality from CKD has climbed over 70% since 1990, even after adjusting for demographics—a trend that demands urgent action.

Indigenous communities face disproportionate burdens, with higher prevalence, faster progression, and poorer outcomes at younger ages. Similarly, Black and South Asian populations show elevated risks, often linked to higher diabetes incidence. The SHN study builds on this by zooming into immigrant experiences, where dialysis prevalence was 4.2 times higher than in Canadian-born residents.

Disparities by Country of Birth: A Clear Pattern Emerges

The study's dialysis cohort revealed immigrants overrepresented by 145-143% compared to census data. Those born in the Caribbean showed the starkest disparity—272-296% higher prevalence, with specific nations like Guyana (446%) and Jamaica (260%) at 8.7-12.1 times the Canadian rate. Southeast Asians, particularly Filipinos, clocked in at 200%, while South Asians from Sri Lanka and India faced 147-143% elevations.

These gaps persisted regardless of immigration year; risks did not diminish even after decades in Canada. For instance, Caribbean-born individuals exhibited higher baseline blood pressure and hemoglobin A1c levels, signaling poorer control of key risk factors. The full BMJ Open publication details how these patterns challenge assumptions about assimilation reducing health inequities.

Ethnicity's Role: Nuanced but Significant

While country of birth dominated, ethnicity also played a part, albeit less pronounced. Southeast Asians had 1.53-1.41 times higher dialysis rates, Blacks 1.26-1.20 times, and South Asians 1.19-1.09 times compared to White residents. East Asians showed moderate elevations, while Whites were underrepresented.

In the non-dialysis cohort, diabetes odds were 4.4 times higher for South Asians and 3.7 times for Southeast Asians versus Whites. Hypertension hovered above 90% universally, but coronary artery disease was lower in East Asians. These ethnic variances suggest a mix of genetic predispositions and lifestyle factors carried from home countries.

Risk Factors Under the Microscope: Diabetes and Beyond

Diabetes, a leading CKD driver, was markedly higher in high-risk immigrant groups: odds ratios of 4.9 for South Asia-born, 3.7 for Southeast Asia-born, and 2.5 for Caribbean-born. Control proved challenging; Black ethnicity correlated with 0.9% higher A1c, and Jamaican- or Sri Lankan-born patients showed similar elevations.

Blood pressure management faltered in Black and certain immigrant subgroups, accelerating damage. Socioeconomic deprivation, measured via Ontario's Marginalization Index, compounded issues—47% of South Asian and 46% of Caribbean dialysis patients lived in the most deprived quintile, versus 34% of Whites.

Photo by Kyle Hinkson on Unsplash

CKD Progression: Faster Decline in At-Risk Groups

Over three years, estimated glomerular filtration rate (eGFR)—a key kidney function measure—declined faster in immigrants (-0.5 mL/min/1.73m² annually) than Canadian-born. Caribbean-, South Asian-, and East Asian-born patients saw the steepest drops, as did Black, South Asian, and East Asian ethnicities.

Proteinuria, excess protein in urine signaling damage, rose quickest in immigrants (+7% yearly), peaking in Caribbean (+12%), Southeast Asian (+8%), and South Asian (+8%) groups. Baseline albuminuria was 81% higher in immigrants, with rapid worsening in high-risk birth countries.

Socioeconomic and Systemic Contributors

Adjusted analyses accounted for age, sex, BMI, and deprivation, yet disparities endured. Scarborough's material deprivation—linked to income, housing, and education—exacerbated risks, particularly for visible minorities. Universal healthcare mitigates access barriers, but upstream factors like diet, stress, and undiagnosed conditions persist.

Dr. Sikaneta noted, “What I was seeing on the dialysis units didn’t feel random.” His work, started in 2018, uses local data to pivot from observation to intervention. SHN Foundation highlights how this informs scalable models.

Indigenous and Other Vulnerable Populations

Beyond immigrants, Indigenous Canadians endure 2-4 times higher kidney failure rates, with rapid progression tied to diabetes and limited rural care. Black communities face elevated risks from hypertension, while South Asians grapple with metabolic syndrome. The Kidney Foundation's forthcoming 2026 National Framework aims to unify prevention efforts, drawing from Australian and U.S. models.

Equity demands culturally sensitive outreach, like community health workers in ethnic enclaves, to boost screening uptake.

Toward Targeted Screening and Prevention

The SHN study advocates redesigning screening: earlier, risk-stratified checks for high-prevalence groups, akin to breast cancer protocols. SHN plans community outreach and proactive monitoring to curb end-stage disease. Dr. Sikaneta envisions, “We could set an example with earlier screening right here in Scarborough.”

Nationally, lifestyle interventions—diet, exercise, blood sugar management—offer promise. Public education on silent CKD symptoms (fatigue, swelling) is crucial, as most cases go undiagnosed until advanced.

Research Implications for Canadian Academia

This clinician-led research exemplifies how hospital-university partnerships drive equity-focused science. SHN's ties to institutions like the University of Toronto amplify its reach, training nephrologists in population health. Future studies must explore gene-environment interactions and longitudinal immigrant cohorts.

Funding from bodies like CIHR could scale such work, informing medical curricula on cultural competence and disparity mitigation.

Photo by Rukmini Chaitanya Kondamudi on Unsplash

Path Forward: Policy, Community, and Hope

Canada's Kidney Foundation urges a national strategy emphasizing surveillance, equitable care, and data-driven policy. By addressing root causes—poverty, food insecurity, healthcare literacy—disparities can narrow. Patients like Maureen Skeete, a Barbadian immigrant on dialysis, embody resilience, but prevention is key.

Stakeholders, from policymakers to educators, must collaborate for a kidney-healthy future. Actionable steps include subsidized screenings in ethnic hubs and research grants for immigrant health. With evidence like the SHN study, Canada can lead in equitable nephrology.