TORONTO—The number of Canadian kidney failure patients has tripled in the last 20 years, but rates have been stabilizing, according to a report from the Canadian Institute for Health Information (CIHI).
The Canadian Organ Replacement Registry annual report, Treatment of End-Stage Organ Failure in Canada, 2000 to 2009, showed that close to 38,000 Canadians were living with kidney failure in 2009—more than triple the number (11,000) living with the disease in 1990. The largest increase occurred in older age groups, with prevalence rates escalating by more than 50 percent for those age 75 and older. Patients in this age group account for 20 percent of all kidney failure cases.
Of all Canadians living with the disease in 2009, 59 percent (22,300) were on dialysis and about 3,000 people were on the wait list for a transplant, compared with 53 percent (5,900) on dialysis in 1990 and roughly 1,600 people on the wait list.
“While the number of kidney failure patients has been increasing in Canada, the supply of kidneys available for transplant has not kept pace with the growing demand,” said Louise Moist, nephrologist and associate professor of medicine at the University of Western Ontario. “Dialysis treatments come at great cost not only to the healthcare system but also to the patients’ quality of life. On average, dialysis patients require treatment in a dialysis centre three times per week, often for four hours per session.”
CIHI’s report also showed that the rate of people living with kidney failure steadily increased between 1990 and 2000 but appears to have leveled off since 2005. This may be due, in part, to patients seeing a nephrologist in earlier stages of the disease, possibly contributing to a delay in the onset of kidney failure.
“Diabetes continues to be a leading cause of kidney failure,” said Moist. “With rising obesity rates and an aging population, there needs to be a focus on educating Canadians on how to prevent the onset of these diseases that add a heavy burden to our health care system.”
Kidney failure results in substantial costs to the health care system. For example, CIHI’s estimated cost for hemodialysis treatment is approximately C$60,000 per patient, per year of treatment. A one-time cost for a kidney transplant is approximately C$23,000 plus C$6,000 for necessary annual medication to maintain the transplant. Based on CIHI’s estimates, over a five-year period, the cost savings of receiving a transplant rather than dialysis treatment is approximately C$250,000 per patient.
In 2009, the more than 15,000 patients living with kidney transplants saved the healthcare system an estimated C$800 million. There are currently about 3,000 people on the wait list for a kidney transplant. If they all receive a transplant, it could result in additional savings of C$150 million annually.
The report also found that in 2009, there were 5,400 newly diagnosed patients with kidney failure—more than double the number of people newly diagnosed in 1990 (2,300). Of the 5,400, more than three-quarters (78 percent) were treating the disease using hemodialysis. The average age of new adult patients starting hemodialysis—the most common form of dialysis—was 65 in 2009, up from 55 in 1990.
People are seeing nephrologists sooner, which is a very positive trend, according to the report. In 2009, 31 percent of patients were “late referrals” (patients that need to start dialysis less than three months after first seeing a nephrologist)—down from 42 percent in 2001.
Diabetes continues to be the predominant cause of kidney failure in Canada: one in three people with kidney failure has diabetes. Of all Canadians with kidney failure in 2009, 39 percent were living with functioning kidney transplants, compared with 47 percent in 1990.
