TORONTO - The number of people living with kidney failure more than tripled in Canada in the last 20 years, new statistics show, but experts hope to save lives and millions of dollars in dialysis costs by expanding organ donor programs.
A report released Thursday by the Canadian Institute for Health Information shows that at the end of 2009, there were 37,744 people being treated for end-stage renal disease, with 59 per cent of them on dialysis and 41 per cent living with a functioning kidney transplant.
Kidney failure rates appear to be stabilizing, but the supply of organs available for transplant has not kept pace with growing demand.
About 3,000 people were on waiting lists for a transplant in 2009. If they all received a transplant, it could result in annual savings of $150 million, the institute estimated.
A number of factors led to the rise in the number of people with kidney failure over the past two decades, said Dr. Peter Nickerson, medical director for transplants for Canadian Blood Services
"We have an aging demographic in the country -- as people get older and as the baby boom tide goes through an older age group, then the prevalence of diseases of age start to become more prevalent," he explained in an interview.
"And then the other thing that we've seen is that the incidence of diabetes has been increasing in this country, and that's related to, in part, obesity as that's become more and more a problem in the country."
About a third of kidney diseases are accounted for by diabetic kidney disease, he said, and another 15 per cent are attributed to renal vascular disease. Other reasons for kidney failure include autoimmune diseases such as lupus, and polycystic kidney disease.
The numbers are stabilizing now because of early intervention and efforts to slow the progression of disease so that patients might not need dialysis, he said.
Early referrals can lead to efforts to control blood pressure and cholesterol, and participation in exercise programs, he added.
The report showed that kidney failure prevalence rates in 2009 were highest in Manitoba and Newfoundland and Labrador, and lowest in Alberta, Quebec and Saskatchewan.
As for transplants, Nickerson said deceased donation tends to be better than average in Quebec and Atlantic Canada, at between 16 and 19 donors per million population.
"If you look at the U.S., the average donation rate is around 26 to 28 donors per million; if you look at Spain, it's up in the 30 donors per million range," Nickerson said.
"Donation rates can be significantly higher than what they are currently in Canada. And we've been stuck at this sort of 14 to 15 national average for a number of years now."
Between 2000 and 2009, there were 10,641 kidney transplant procedures registered in the Canadian Organ Replacement Registry. Of these, 11 per cent were re-transplants. Of the 9,430 kidney-only first transplants, 61 per cent used deceased donor kidneys.
Since 2006, the number of living donor kidney transplants has been stable, fluctuating between 440 and 461 transplants per year.
Nickerson said the deputy ministers of health have asked Canadian Blood Services to lead a review designed to enhance organ donation for transplantation in Canada.
Strategies are needed to raise awareness and get people to sign organ donor cards, he suggested.
"Ninety per cent support transplantation, but when you ask how many have actually taken the action to sign their donor card or tell somebody, only about 45 to 50 per cent of us have done that," he said.
The median wait time for a deceased-donor kidney transplant from 2007 to 2009 was 3.6 years, with the longest waits in British Columbia and Ontario, the CIHI report showed.
Louise Moist, a nephrologist at the University of Western Ontario in London, Ont., said dialysis treatments come at great cost to the health-care system and 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," she said in a release.
CIHI estimated the annual cost of hemodialysis treatment at $60,000 per patient, compared to a one-time cost of $23,000 for a transplant plus $6,000 per year for medication.
Nickerson said savings are about $250,000 over five years.
"Sixteen to 20 years is the average expectancy of a living donor kidney transplant," he said, adding that deceased donor transplants would probably last 10 to 12 years.
British Columbia has one of the country's best living donor rates. On Thursday, Health Minister Colin Hansen encouraged residents to learn more about registering to become an organ donor.
"Transplants depend on organ donation and the availability of organs for transplant, and I would like to acknowledge the living donors and families of deceased donors who made the difficult decision to donate organs that saved the lives of thousands of people across the province," he said in a statement.
Canadian Blood Services recently launched a paired kidney exchange registry, which allows pairs to receive and donate a kidney from among other registered pairs even if they're not matches for each other.
Nickerson said 185 pairs are registered, and 65 kidney transplants have been done that otherwise wouldn't have occurred.
"And we know that this is only the beginning," he said.
"We estimate that we should have on an annual basis another 200 to 250 pairs joining annually and that we can facilitate about half of them finding transplants on a yearly basis."
