Op-Ed: A wake-up call for the country
The following is an Op-Ed by Allison B. Dart and Mariette J. Chartier. Dart is an adviser with EvidenceNetwork.ca, and an assistant professor in the pediatrics and child health department at the University of Manitoba.Chartier is a research scientist at the Manitoba Centre for Health Policy and an assistant professor in the community health sciences department at the University of Manitoba. This column was originally on Dec, 21, 2016.
As many as 40,000 Canadians are affected by kidney failure — a problem that is increasing across the country, with significant consequences for our health system.
A report we released recently from the Manitoba Centre for Health Policy projects a 68 per cent increase to the number of Manitobans requiring dialysis or a kidney transplant in the next decade.
Manitoba already has among the highest rates of kidney failure in Canada, but it is not alone.
Those rates are highest in Newfoundland and Labrador, affecting approximately 1,500 people per million, and rising. But 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.
One could view the projected rates in Manitoba as a wake-up 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 affect the lives of people with kidney failure.
Those most affected include the most vulnerable: people living in remote northern communities, in lower-income areas and the elderly.
The economic costs to the health system are also significant. The biggest projected growth is expected in centre-based hemodialysis, which costs the health-care system up to $107,000 per year.
Diabetes and high blood pressure are among important health-related risk factors for kidney disease. Diabetes rates increase yearly 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 affected during their lifetime.
Our report looks at the impact of diabetes on the future rates of kidney failure. In this what-if scenario, the research team found 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 the rates decreased.
In other words, diabetes prevention could go a long way in addressing kidney disease in the population, too.
Our report estimates as many as 14 per cent of adults and a surprising three per cent of children have kidney disease in Manitoba. Many of them are at high risk of disease progression.
With such alarming numbers across the country, it is clear Canada needs a strategy to combat kidney disease.
What should this strategy look like? We need 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 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 strategy to target screening for high-risk populations, including northern indigenous populations and those with known high blood pressure and diabetes.
Third, we need a surveillance system in place to track progress of those with kidney disease, and ensure at-risk individuals receive the care they need, including therapies to control blood sugar and blood pressure. These approaches slow the progression of kidney disease.
Finally, individuals with more aggressive or advancing disease must be referred for specialty care from kidney doctors, nurses, dieticians, social workers and pharmacists.
The rising rates of kidney failure in Manitoba 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.
Research at the University of Manitoba is partially supported by funding from the Government of Canada Research Support Fund.