End-stage renal disease in Canada: prevalence projections to 2005

Background: The incidence and prevalence of end-stage renal disease (ESRD) have increased greatly in Canada over the last 2 decades. Because of the hi gh cost of therapy, predicting numbers of patients who will require dialysi s and transplantation is necessary for nephrologists and health care planne rs. Methods: The authors projected ESRD incidence rates and therapy-specific pr evalence by province to the year 2005 using 1981-1996 data obtained from th e Canadian Organ Replacement Register. The model incorporated Poisson regre ssion to project incidence rates, and a Markov model for patient follow-up. Results: Continued large increases in ESRD incidence and prevalence were pr ojected, particularly among people with diabetes mellitus. As of Dec. 31, 1 996, there were 17807 patients receiving renal replacement therapy in Canad a. This number was projected to climb to 32952 by the end of 2005, for a re lative increase of 85% and a mean annual increase of 5.8%. The increased pr evalence was projected to be greatest for peritoneal dialysis (6.0% annuall y), followed by hemodialysis (5.9%) and functioning kidney transplant (5.7% ). The projected annual increases in prevalence by province ranged from 4.4 %, in Saskatchewan, to 7.5%, in Alberta. Interpretation: The projected increases are plausible when one considers th at the incidence of ESRD per million population in the United States and ot her countries far exceeds that in Canada. The authors predict a continued a nd increasing shortfall in resources to accommodate the expected increase i n ESRD prevalence.