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Table of Contents
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Table E.1: Physical Health of Adults in Chronic Kidney Disease Patient Cohorts
Table E.2: Observed and Predicted Number of End Stage Kidney Disease Patients
	by Region and Treatment Type, 2012 and 2024
Table 2.1: Comparison Between the Distribution of Regional Populations and Creatinine Tests,
	2006/07-2011/12
Table 2.2: Inclusion and Exclusion Criteria for Children in the Chronic Kidney Disease Validation Cohort
Table 2.3: Heat Map (Risk of Progression to ESKD) of Chronic Kidney Disease
Table 3.1: Heat Map (Risk of Progression to ESKD) of Adults with Chronic Kidney Disease
Table 3.2: Prevalence of Chronic Kidney Disease in Children by Estimation Method
	Rates per 100 residents aged 0-17 on March 31, 2012
Table 3.3: Number of Children with Chronic Kidney Disease Identified with Administrative Data Case Definitions and Laboratory Data
Table 3.4: Validity of Administrative Data Case Definitions of Chronic Kidney Disease Compared to Laboratory Data
Table 3.5: Heat Map (Risk of Progression to ESKD) of Children with Chronic Kidney Disease on March 31, 2012
Table 4.1: Physical Health of Adults in End Stage Kidney Disease Patient Cohorts
Table 4.2: Mental Disorders in Adults in End Stage Kidney Disease Patient Cohorts
Table 4.3: Use of Prescription Drugs by Adults in End Stage Kidney Disease Patient Cohorts
Table 4.4: Healthcare Use by Adults in End Stage Kidney Disease Patient Cohorts
Table 4.5: Physical Health of Adults in Chronic Kidney Disease Patient Cohorts
Table 4.6: Mental Disorders in Adults in Chronic Kidney Disease Patient Cohorts
Table 4.7: Use of Prescription Drugs by Adults in Chronic Kidney Disease Patient Cohorts
Table 4.8: Healthcare Use by Adults in Chronic Kidney Disease Patient Cohorts
Table 5.1: Physical Health of Children in Patient Cohorts
Table 5.2: Mental Disorders in Children in Patient Cohorts
Table 5.3: Use of Prescription Drugs by Children in Patient Cohorts
Table 5.4: Healthcare Use by Children in Patient Cohorts
Table 6.1: Observed and Predicted Number of End Stage Kidney Disease Patients
	by Region and Treatment Type, 2012 and 2024
Table 6.2: Observed and Projected Number of Patients with End Stage Kidney Disease in Manitoba,
	by “What If“ Projection Scenario and Treatment Type, 2012 and 2024
Table 7.1: Factors Associated with Starting Centre-Based Hemodialysis Compared to
	Other Treatment Types, 2007/08-2011/12
Table 8.1: Inclusion and Exclusion Criteria for Patients in the Kidney Failure Risk Equation
	Validation Cohort by End Stage Kidney Disease (ESKD) Group
Table 8.2: Accuracy of Screening Thresholds for Five-Year Progression to End Stage Kidney Disease (ESKD)
Appendix Table 2.1: Transitional Probability Matrix for Patients with End Stage Kidney Disease  and Diabetes Winnipeg residents,
	January 1, 2004-March 31, 2012
Appendix Table 2.2: Odds Ratios of State Transition in Patients with End Stage Kidney Disease
Appendix Table 3.1: Comparison Between Patients with Chronic Kidney Disease by Risk of Progression
	to End Stage Kidney Disease, March 31, 2012
Appendix Table 4.1: Relative Risks Comparing Rates of Chronic Kidney Disease in Adults
	by Region to the Manitoba Rate, by Risk of Progression to End Stage Kidney Disease
Appendix Table 4.2: Relative Risks Comparing Rates of End Stage Kidney Disease in Adults
	by Region to the Manitoba Rate, by Treatment Type
Appendix Table 5.1: Characteristics of Children in the Chronic Kidney Disease Validation Cohort
Appendix Table 6.1: Relative Risks Comparing Rates of Chronic Kidney Disease in Children
	by Region to the Manitoba Rate, by Risk of Progression to End Stage Kidney Disease
Appendix Table 7.1: Observed and Projected Number of Patients with End Stage Kidney Disease
	in Winnipeg Health Region, by “What If“ Projection Scenario and Treatment Type,
	2012 and 2024
Appendix Table 7.2: Observed and Projected Number of Patients with End Stage Kidney Disease
	in Southern Health/Santé Sud, by “What If“ Projection Scenario and Treatment Type, 					2012 and 2024
Appendix Table 7.3: Observed and Projected Number of Patients with End Stage Kidney Disease
	in Prairie Mountain Health Region, by “What If“ Projection Scenario and
	Treatment Type, 2012 and 2024
Appendix Table 7.4: Observed and Projected Number of Patients with End Stage Kidney Disease
	in Northern Health Region, by “What If“ Projection Scenario and Treatment Type,
	2012 and 2024
Appendix Table 7.5: Observed and Projected Number of Patients with End Stage Kidney Disease
	in Interlake-Eastern Health Region, by “What If“ Projection Scenario and
	Treatment Type, 2012 and 2024
Appendix Table 8.1: Characteristics of Patients with Chronic Kidney Disease (CKD) in the
	Kidney Failure Risk Equation Validation Cohort by CKD Severity
Appendix Table 8.3: Characteristics and Predicted Risk Thresholds of Patients
	with End Stage Kidney Failure
Figure 2.1: Manitoba Health Regions, Remote Communities and Location of Dialysis Centres
Figure 3.1: Number of Adults with Chronic Kidney Disease (CKD) or End Stage Kidney Disease (ESKD),
	and Percentage Seen by Nephrologist by Data Source
Figure 3.2: Prevalence of Adults with Chronic Kidney Disease by Region and Estimation Method
Figure 3.3: Adults in Risk Groups of Chronic Kidney Disease by Region
Figure 3.4: Prevalence of End Stage Kidney Disease by Health Region Zones in Manitoba, March 2012
Figure 3.5: End Stage Kidney Disease Prevalence by Region, 2004-2012
Figure 3.6: End Stage Kidney Disease Incidence by Region, 2004-2011
Figure 3.7: Observed Number of Patients with End Stage Kidney Disease by Treatment Type, 2004-2012
Figure 3.8: Number of Patients with End Stage Kidney Disease who Start and Stop Dialysis, 2004-2012
Figure 3.9: Treatment Type of Adults with End Stage Kidney Disease by Region
Figure 3.10: Number and Percent of Adults on Dialysis (2012) and Annual Cost per Person*
Figure 3.11: Number of Children with Chronic Kidney Disease (CKD) or End Stage Kidney Disease (ESKD),
	and Percentage Seen by Nephrologist by Data Source
Figure 3.12: Children in Risk Groups of Chronic Kidney Disease and End Stage Kidney Disease by Region
Figure 4.1: Treatment Type of Adults with End Stage Kidney Disease by Age and Sex
Figure 4.2: Treatment Type of Adults with End Stage Kidney Disease by Rural and Urban Income Quintile
Figure 4.3: Adults in Risk Groups of Chronic Kidney Disease by Age and Sex
Figure 4.4: Adults in Risk Groups of Chronic Kidney Disease by Income Quintile
Figure 5.1: Children in Risk Groups of Chronic Kidney Disease and End Stage Kidney Disease
	by Age and Sex
Figure 5.2: Children in Risk Groups of Chronic Kidney Disease and End Stage Kidney Disease
	by Income Quintile
Figure 6.1: Observed and Projected Number of Patients with End Stage Kidney Disease
	by Treatment Type in Manitoba, 2004-2024
Figure 6.2: Observed and Projected Number of Patients with End Stage Kidney Disease
	by Treatment Type in Winnipeg, 2004-2024
Figure 6.3: Observed and Projected Number of Patients with End Stage Kidney Disease
	by Treatment Type in Southern Health/Santé Sud Region, 2004-2024
Figure 6.4: Observed and Projected Number of Patients with End Stage Kidney Disease
	by Treatment Type in Prairie Mountain Health Region, 2004-2024
Figure 6.5: Observed and Projected Number of Patients with End Stage Kidney Disease
	by Treatment Type in Northern Health Region, 2004-2024
Figure 6.6: Observed and Projected Number of Patients with End Stage Kidney Disease
	by Treatment Type in Interlake-Eastern Health Region, 2004-2024
Figure 6.8: Observed and Projected Number of End Stage Kidney Disease Patients Without Diabetes
	by Treatment Type in Manitoba, 2004-2024
Figure 6.9: Observed and Projected Number of End Stage Kidney Disease Patients Aged 0-44
	by Treatment Type in Manitoba, 2004-2024
Figure 6.11: Observed and Projected Number of End Stage Kidney Disease Patients Aged 65+
	by Treatment Type in Manitoba, 2004-2024
Figure 6.12: Observed and Projected Number of End Stage Kidney Disease Patients
	by Treatment Type in Manitoba if Diabetes Prevalence is Constant, 2004-2024
Figure 6.13: Observed and Projected Number of End Stage Kidney Disease Patients
	by Treatment Type in Manitoba if 30% of Dialysis Starts are Peritoneal Dialysis, 2004-2024
Figure 6.14: Observed and Projected Number of End Stage Renal Disease Patients
	by Treatment Type in Manitoba if 8% of Dialysis Starts are Home Hemodialysis, 2004-2024
Figure 6.15: Observed and Projected Number of End Stage Kidney Disease Patients
	by Treatment Type in Manitoba if Kidney Transplant Rate Increased by 25%, 2004-2024
Acronyms
Executive Summary
	Introduction
	Purpose of This Report
	Methods
	Results
		Disease Prevalence in 2012
		Characteristics  of People with Chronic Kidney Disease and End Stage Kidney Disease
		Projections of the Number of Manitobans Requiring Treatment for Kidney Failure (2012 – 2024)
	Risk Factors, Screening, Prevention and Treatment Strategies
	Conclusions and Recommendations
Chapter 1: Introduction and Background
	Purpose of This Report
	What You Will Find in This Report
	Disease Background
		Causes
		Diagnosis
		Progression, Comorbidities and Complications
		Disease Management and Treatment
		Healthcare Use and Costs
	Epidemiology
		Historical Trends
		Projections
	Treatment, Screening and Prevention Strategies
Chapter 2: Methods
	Geographical Boundaries
		Data Sources
		Diagnostic Services Manitoba Data
		Manitoba Renal Program Data
	Chronic Kidney Disease and End Stage Kidney Disease Cohorts
		People with Chronic Kidney Disease
		People with End Stage Kidney Disease
	Analyses
		Cohort Characteristics
		Chronic Kidney Disease Prevalence
		End Stage Kidney Disease Incidence and Prevalence
		End Stage Kidney Disease Projections
		Factors Associated with Centre-Based Hemodialysis
		Kidney Failure Risk Equation
Chapter 3: Cohort Description: Chronic Kidney Disease and End Stage Kidney Disease
	Key Findings
		Adult Cohort
		Child Cohort
		Adults with Chronic Kidney Disease and End Stage Kidney Disease
		Prevalence of Chronic Kidney Disease in Adults
		Classification of Adults with Chronic Kidney Disease by Disease Severity
		Prevalence and Incidence of End Stage Kidney Disease in Adults
		Type of Renal Replacement Therapy
		Dialysis Distribution and Costs
	Children with Chronic Kidney Disease and End Stage Kidney Disease
		Prevalence of Chronic Kidney Disease in Children in Manitoba
		End Stage Kidney Disease in Children in Manitoba
		Validation of Administrative Data Definition for Chronic Kidney Disease in Children
		Classification of Children with Chronic Kidney Disease by Disease Severity
Chapter 4: Characteristics of Adults with End Stage Kidney Disease and Chronic Kidney Disease
	Key Findings
		Adults with End Stage Kidney Disease
		Adults with Chronic Kidney Disease
	Characteristics of Adults with End Stage Kidney Disease
		Sociodemographic Characteristics
		Physical Health
		Mental Health
		Use of Prescription Drugs
		Healthcare Services Use
	Characteristics of Adults with Chronic Kidney Disease
		Sociodemographic Characteristics
		Physical Health
		Mental Health
		Use of Prescription Drugs
		Healthcare Services Use
Chapter 5: Characteristics of Children with End Stage Kidney Disease and Chronic Kidney Disease
	Key Findings
		Sociodemographic Characteristics
		Physical Health
		Mental Health
		Use of Prescription Medication
		Healthcare Services Use
Chapter 6: Observed Patterns and Projections of the Number of Manitobans Requiring Treatment for End Stage Kidney Disease
	Key Findings
	Projections of the Number of Manitobans Requiring Treatment for End Stage Kidney Disease, 2012-2024
		Projections for Manitoba and for Each Health Region
		Projections by Diabetes Status
		Projections by Age Group
		“What If” Projection Scenarios
		Diabetes Prevalence Remains at 2012 Levels
		Peritoneal Dialysis Starts Increase to 30% of all Dialysis Starts
		Home Hemodialysis Starts Increase to 8% of all Dialysis Starts
		Kidney Transplants Increase by 25%
		Mortality Rates for People with End Stage Kidney Disease Decrease by 20%
Chapter 7: Risk Factors and Screening, Prevention and Treatment Strategies for Chronic Kidney Disease and End Stage Kidney Disease
	Key Findings
	Findings from Previous Studies and the Present Report
		Risk Factors Associated with Chronic Kidney Disease and End Stage Kidney Disease
		Prevention of Chronic Kidney Disease
		Screening and Monitoring Strategies for Adults
		Treatment of Adults with Chronic Kidney Disease
	Factors Associated with End Stage Kidney Disease Treatment Type in Manitoba
	Current Screening, Prevention and Treatment Initiatives in Manitoba
		The First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis (FINISHED) Project
		Risk-Based Triage
		Nurse-Led Telehealth Clinics in Thompson
		Renal Health Outreach
		Electronic Kidney Health Record (eKHR)
Chapter 8: Kidney Failure Risk Equation
	Key Findings
	Methods of the Validation Study
	Validation and Application in Manitoba
Chapter 9: Summary of Results and Recommendations
	Summary of Results
		What are the future needs for renal health services (dialysis and kidney transplants) in Manitoba?
		What is the geographic distribution of this population?
		What are the characteristics of the future population of Manitoba residents who will require renal replacement treatment?
		What preventive, screening, and education measures and affiliations with existing programs might reduce the number of Manitobans who will require dialysis? (i.e., what are the modifiable risk factors?)
	Recommendations
		Develop a comprehensive public health strategy for chronic diseases (including kidney disease) in Manitoba
		Address the social determinants of health
		Implement a targeted chronic kidney disease screening and surveillance system
		Build capacity to address chronic kidney disease among primary care physicians and pediatricians
		Increase the use of peritoneal dialysis and home hemodialysis to 30% of all dialysis starts
		Develop and implement strategies to increase availability of kidneys for transplant
		Evaluate the process and outcomes of new screening and early intervention strategies to inform future policy direction
Reference List
Glossary
Appendix 1: Technical Definitions of Indicators and Measures Used in Report
Appendix 2: Markov Model Transitional Probability Matrix
Appendix 3: Comparison Between Patients with Chronic Kidney Disease by Risk of Progression to End Stage Kidney Disease
Appendix 4: Relative Risks Comparing Rates of Chronic Kidney Disease and End Stage Kidney Disease in Adults by Region to the Manitoba Rate
Appendix 5: Validation of Administrative Data Definition of Chronic Kidney Disease in Children
Appendix 6: Relative Risks Comparing Rates of Chronic Kidney Disease in Children by Region to the Manitoba Rate
Appendix 7: Summary of “What If” Projection Scenarios by Health Region
Appendix 8: Kidney Failure Risk Equation (KFRE) Cohort
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Document Text Contents
Page 1

Authors:
Mariette Chartier, RN, PhD
Allison Dart, MD, MSc, FRCPC
Navdeep Tangri, MD, PhD, FRCPC
Paul Komenda, MD, FRCPC, MHA, CHE
Randy Walld, BSc, B. Comm (Hons)
Bogdan Bogdanovic, B. Comm, BA (Econ)
Charles Burchill, MSc
Ina Koseva, MSc
Kari-Lynne McGowan, MSc
Leanne Rajotte, B. Comm (Hons)

December 2015

Manitoba Centre for Health Policy
College of Medicine
Faculty of Health Sciences
University of Manitoba

CARE OF MANITOBANS LIVING
WITH CHRONIC KIDNEY DISEASE

Page 2

This report is produced and published by the Manitoba Centre for Health Policy (MCHP).
It is also available in PDF format on our website at:
http://mchp-appserv.cpe.umanitoba.ca/deliverablesList.html

Information concerning this report or any other report produced by MCHP can be obtained
by contacting:

Manitoba Centre for Health Policy
Faculty of Health Sciences
College of Medicine, University of Manitoba
4th Floor, Room 408
727 McDermot Avenue
Winnipeg, Manitoba, Canada
R3E 3P5

Email: [email protected]
Phone: (204) 789-3819
Fax: (204) 789-3910

How to cite this report:
Chartier M, Dart A, Tangri N, Komenda P, Walld R, Bogdanovic B, Burchill C, Koseva I,
McGowan K, Rajotte L. Care of Manitobans Living with Chronic Kidney Disease. Winnipeg, MB.
Manitoba Centre for Health Policy, December 2015.

Legal Deposit:
Manitoba Legislative Library
National Library of Canada

ISBN 978-1-896489-80-3

©Manitoba Health

This report may be reproduced, in whole or in part, provided the source is cited.

1st printing (December 2015)

This report was prepared at the request of Manitoba Health, Healthy Living and Seniors
(MHHLS) as part of the contract between the University of Manitoba and MHHLS. It was
supported through funding provided by the Department of Health of the Province of
Manitoba to the University of Manitoba (HIPC 2012/2013-21). The results and conclusions
are those of the authors and no official endorsement by MHHLS was intended or should be
inferred. Data used in this study are from the Population Health Research Data Repository
housed at the Manitoba Centre for Health Policy, University of Manitoba and were derived
from data provided by MHHLS, as well as the Winnipeg Regional Health Authority,
Diagnostic Services Manitoba, and the Vital Statistics Agency. Strict policies and procedures
were followed in producing this report to protect the privacy and security of the Repository
data..

Page 89

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Chapter 5 | page 67

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UNIVERSITY OF MANITOBA, FACULTY OF HEALTH SCIENCES umanitoba.ca/medicine/units/mchp/
page 68 | Chapter 5

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umanitoba.ca/medicine/units/mchp/

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Azimaee, Matthew Dahl, Patrick Nicol, Charles Burchill, Elaine Burland, Chun Yan Goh, Jennifer Schultz and
Angela Bailly

Perinatal Services and Outcomes in Manitoba by Maureen Heaman, Dawn Kingston, Michael Helewa, Marni
Brownlee, Shelley Derksen, Bodgan Bogdanovic, Kari–Lynne McGowan, and Angela Bailly

How Are Manitoba’s Children Doing? By Marni Brownell, Mariette Chartier, Rob Santos, Oke Ekuma, Wendy
Au, Joykrishna Sarkar, Leonard MacWilliam, Elaine Burland, Ina Koseva, and Wendy Guenette

Projecting Personal Care Home Bed Equivalent Needs in Manitoba Through 2036 by Dan Chateau, Malcolm
Doupe, Randy Walld, Ruth–Ann Soodeen, Carole Ouelette, and Leanne Rajotte

Health and Healthcare Utilization of Francophones in Manitoba by Mariette Chartier, Gregory Finlayson,
Heather Prior, Kari–Lynne McGowan, Hui Chen, Janelle de Rocquigny, Randy Walld, and Michael Gousseau

The Early Development Instrument (EDI) in Manitoba: Linking Socioeconomic Adversity and Biological
Vulnerability at Birth to Children’s Outcomes at Age 5 by Rob Santos, Marni Brownell, Oke Ekuma, Teresa
Mayer, and Ruth–Ann Soodeen

The Epidemiology and Outcomes of Critical Illness in Manitoba by Alan Garland, Randy Fransoo, Kendiss Olafson, Clare
Ramsey, Marina Yogendran, Dan Chateau, and Kari–Lynne McGowan

2011
Adult Obesity in Manitoba: Prevalence, Associations, and Outcomes by Randy Fransoo, Patricia Martens, Heather Prior,
Dan Chateau, Chelsey McDougall, Jennifer Schultz, Kari–Lynne McGowan, and Angela Bailly

Manitoba Immunization Study by Tim Hilderman, Alan Katz, Shelley Derksen, Kari–Lynne McGowan, Dan Chateau,
Carol Kurbis, Sandra Allison, Ruth–Ann Soodeen, and Jocelyn Nicole Reimer

Population Aging and the Continuum of Older Adult Care in Manitoba by Malcolm Doupe, Randy Fransoo, Dan
Chateau, Natalia Dik, Charles Burchill, Ruth–Ann Soodeen, Songul Bozat–Emre, and Wendy Guenette

page 156

Similer Documents