By Allison Dart
and Mariette Chartier
University of Manitoba
As many as 40,000 people in Canada are affected by kidney failure – and the problem is increasing across the country, with significant consequences for our health system.
A report we released this month from the Manitoba Centre for Health Policy projects an increase of 68 per cent in the number of Manitobans requiring dialysis or kidney transplant in the next decade. Manitoba already has among the highest rates of kidney failure in Canada, but it is not alone.
Rates of kidney failure are highest in Newfoundland and Labrador, affecting about 1,500 people per million and rising. And most provinces have escalating rates, with about 1,200 per million people affected in B.C., Saskatchewan and Ontario, and 1,000 per million in Alberta.
The projected rates in Manitoba should be a wakeup call for the country as a whole.
Debilitating symptoms, decreased quality of life, mental health issues, financial challenges and frequent need for medical visits and hospitalizations significantly impact the lives of people with kidney failure. Those most affected include those most vulnerable: people in remote northern communities and in lower income areas, and the elderly.
In addition to the human cost of kidney failure, the economic costs to the health system are significant. The biggest projected growth is expected in centre-based hemodialysis, which costs the health-care system up to $107,000 per year per patient.
The most important health-related risk factors for kidney disease include diabetes and high blood pressure. Diabetes in particular continues to increase each year across Canada, in adults and children. Pediatricians now see kids as young as five with high blood pressure due to obesity, and as young as seven with type 2 diabetes. This is especially concerning because of the many years that children have to live with these complications, making it more likely that their health will be impacted in the longer term.
Our report specifically looks at the impact of diabetes on the future rates of kidney failure. The research found that the projected number of people on dialysis could be decreased by nine per cent in Manitoba if current rates of diabetes were kept steady. Imagine the impact if diabetes rates actually decreased.
In other words, diabetes prevention strategies could go a long way in addressing kidney disease.
Our report estimates that as many as 14 per cent of adults and a surprising three per cent of children already have kidney disease in Manitoba. One-third of these adults and 25 per cent of these children are at high risk of progression.
It is clear that Canada needs a public health strategy to combat kidney disease. What should this strategy look like?
It needs to include action from all levels of government, with special attention to unifying care across jurisdictional barriers that affect our highest risk populations, such as First Nations people.
A public health strategy should focus first on creating healthier communities. Children growing up with access to healthy foods and safe places to play are less likely to develop obesity, diabetes and, hence, kidney complications. Healthier choices need to be easier to make than unhealthy ones. Individualized and culturally sensitive education and coaching should be available to adults with unhealthy habits.
Second, we need a strategy to screen high-risk populations, including northern indigenous populations and those with high blood pressure and diabetes.
Third, we need a system to track at-risk individuals and ensure they get the care they need, including therapies to optimize things like blood sugar and blood pressure, since these approaches are proven to slow down kidney disease.
Finally, a strategy should focus on those individuals with more aggressive or advancing disease being referred to specialty care by kidney doctors, nurses, dieticians, social workers and pharmacists.
The rising rates of kidney failure in Manitoba, and the projected significant rise, are symptoms of many health issues across the country. A unified approach is required to make meaningful change for the many Canadians at risk. It may save lives and save our health system millions of dollars.
Allison B. Dart is a pediatric kidney specialist and assistant professor in the Department of Pediatrics and Child Health, University of Manitoba. Mariette J. Chartier is a research scientist at the Manitoba Centre for Health Policy and an assistant professor in the Department of Community Health Sciences, Faculty of Medicine, University of Manitoba.