As many as 40 thousand people in Canada are affected by kidney failure – a problem that is increasing across the country, with significant consequences for our health system.
A report 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 amongst the highest rates of kidney failure in Canada but it is not alone.
Rates of kidney failure are actually the highest in Newfoundland and Labrador, affecting approximately 1500 per million and rising. But most provinces have escalating rates, with about 1200 per million people affected in B.C., Saskatchewan and Ontario, and 1000 per million in Alberta.
One could view the projected rates in Manitoba as a wakeup call for the country at large.
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 living in remote Northern communities, in lower income areas and the elderly.
But in addition to the human cost of bearing the burden of kidney failure, the economic costs to the health system are also significant. The biggest projected growth is expected in center-based hemodialysis, which costs the healthcare 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 is a health problem that continues to increase each year across Canada, in adults and even in children. Pediatricians are now seeing 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 children have to live with these complications, and the higher risk that their health will be impacted during their lifetime.
Our report specifically looks at the impact of diabetes on the future rates of kidney failure. In this “what if” scenario, the research team 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, strategies for addressing diabetes prevention could go a long way in addressing kidney disease in the population too.
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. Moreover, one third of these adults and 25 per cent of these children are at high risk of progression.
With such alarming numbers across the country, 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 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 public health strategy to target screening for high-risk populations, including Northern Indigenous populations, and those with known high blood pressure and diabetes.
Thirdly, once individuals are identified with kidney disease, we need a surveillance system in place to track progress and ensure that at risk individuals are receiving the care they need, including therapies to optimize things like blood sugar and blood pressure as these approaches are proven to slow down kidney disease progression.
Finally, a public health 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 a symptom of many health issues in the population across the country. There are solutions to many of these challenges, including prevention, but a unified approach across jurisdictions is required to make meaningful change for the many Canadians at risk for kidney failure. It may save lives, and it may also save our health system millions of dollars in the process.
Allison B. Dart is an advisor with EvidenceNetwork.ca, 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.