DIALYSIS UTILIZATION IN THE TORONTO REGION FROM 1981 TO 1992

Objective: To analyse trends in the demand for and supply of dialysis in the Toronto region and to determine whether planned dialysis expans ion will be sufficient to provide for the projected growth of the dial ysis population. Design: Descriptive analysis of data reported to the Toronto Region Dialysis Registry between 1981 and 1992, compared with provincial and national equivalents. Setting: All secondary and tertia ry care dialysis programs in the Toronto region participating in the r egistry. Patients: All 504 existing patients enrolled in dialysis prog rams in 1981 and all 3794 new patients entering programs from 1982 to 1992. Patients with acute renal failure were excluded. Main outcome me asures: Demand for dialysis: dialysis population at year end, age dist ribution, crude mortality rate and transplant rate. Supply of resource s: distribution of modality (hemodialysis or peritoneal dialysis), num ber of patients treated per hemodialysis station, number of hemodialys is stations per million population and hemodialysis utilization index (actual/budgeted treatments). Results: During the study period the num ber of dialysis patients in the Toronto region went from 504 to 1422, for an increase of 182.1%. The average rate of growth was 9.8% per yea r. Of the total increment of 918 patients from 1981 to 1992, 390 (42.5 %) were 65 years of age or more; none the less, the average annual cru de mortality rate remained relatively constant, at 13.8% to 17.3%. The transplantation rate declined from a peak of 20.2% in 1982 to 7.8% in 1992. During the study period the Toronto region had much higher numb ers of dialysis patients, and hemodialysis patients, per hemodialysis station than the rest of Ontario or Canada. The region's hemodialysis utilization index was 101% in 1991 and 102% in 1992; the index in indi vidual hospitals varied from 98% to 124% (85% was considered optimal). Conclusions: The growth of the dialysis population in the Toronto reg ion has caused a critical shortage of resources. This trend can be att ributed mainly to a decrease in the transplantation rate and an increa se in the number of elderly patients entering dialysis programs, combi ned with insufficient funding for expansion of facilities. Continuatio n of this trend would be expected to limit universal access to this ex pensive, but life-sustaining therapy.