Dialysis patients younger than 18 have the highest risk of being hospitalized

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February 2, 2017 — More than 21,000 Canadians (excluding Quebecers) were on dialysis in 2015 and, according to a new report, their risk of being hospitalized was highest in the first week of their dialysis treatment. High Risk and High Cost: Focus on Opportunities to Reduce Hospitalizations of Dialysis Patients in Canada, released by the Canadian Institute for Health Information (CIHI), shows that pediatric patients (age 0 to 17) and Indigenous patients had the highest hospitalization risk.

Dialysis is a procedure that cleans the blood through artificial means. It is used mostly for end-stage kidney disease (ESKD), which can be caused by high blood pressure, kidney damage, inherited disorders and, most commonly, diabetes. Many patients on dialysis are waiting for a kidney transplant.

CIHI’s data shows that the number of dialysis patients increased by almost 30% over 10 years — from 16,388 in 2006 to 21,214 in 2015. Dialysis patients are at risk of poorer outcomes and hospitalizations due to complications resulting from infections and other factors. This report examines factors associated with hospitalizations to contribute to efforts to improve outcomes for dialysis patients.

Hospitalizations

CIHI’s study shows that dialysis patients have a higher risk of being hospitalized during the first week of their treatment. The risk is 27% higher for peritoneal dialysis patients than for hemodialysis patients.

Peritoneal dialysis involves inserting dialysis fluid into the abdomen to filter waste from the blood, while hemodialysis circulates the blood from the body into a machine to remove wastes.

Pediatric patients had a 173% higher risk of being hospitalized than any other age group, even when controlling for sex, race and other factors. Kidney disease was the reason for 1 in 4 of those hospitalizations, whereas infection related to dialysis was the reason for almost 1 in 8 hospitalizations.

The study found that Indigenous patients had a 30% higher risk of being hospitalized for dialysis-related infection and a 20% higher risk of all-cause hospitalization. A 2013 CIHI study on ESKD in Indigenous populations showed that Indigenous patients were more likely than non-Indigenous patients to need dialysis and to travel longer distances to receive dialysis treatment. Indigenous patients were also less likely to receive a kidney transplant and had lower survival rates than non-Indigenous patients.  

"Many patients who are on dialysis required hospitalization, often for preventable dialysis-related infections," says Greg Webster, the director of Acute and Ambulatory Care Information Services at CIHI. "Our report emphasizes that dialysis practices by care providers and patients are critical to reducing the risk of infection, since infection is a major cause of hospitalizations, especially for pediatric and Indigenous patients."

Costs

Approximately $310 million a year is spent on hospitalization costs for dialysis patients across Canada, excluding Quebec. The average cost of hospitalization for pediatric patients is almost 3 times greater than the costs for older patients; the average annual cost was $27,344 for patients age 0 to 17, compared with $10,982 for patients age 45 to 64.

Another CIHI study explores the impact of dialysis on a patient's quality of life. Annual Statistics on Organ Replacement in Canada: Dialysis, Transplantation and Donation, 2006 to 2015 reports that less than half (45%) of patients on dialysis survived for 5 years or longer.

Dialysis patients have strict fluid intakes, and individuals often feel thirsty or unwell due to the fluid restrictions. Travel is difficult or sometimes impossible, as patients on hemodialysis require treatments at least 3 times a week for approximately 4 hours per session. Some patients choose not to go through dialysis, opting instead for non-dialysis supportive care, where they try to preserve quality of life.

"Kidney transplantation is not a cure, but it is the preferred treatment option for kidney patients over dialysis," according to Elizabeth Myles, the national executive director of The Kidney Foundation of Canada. "In addition to providing improved health and survival, a patient's quality of life is vastly better. A transplant frees patients from restrictive dialysis treatment routines and dietary requirements. There can also be a positive impact on a family financially and emotionally, as a transplant allows patients to return to work and resume the social activities they enjoy."

Facts and figures

  • At the end of 2015, a total of 36,251 Canadians, excluding Quebecers, were living with ESKD. This number had grown 36% since 2006, from 26,729.
    • Of these patients, 21,214 were on dialysis and 15,037 were living with a functioning kidney transplant.
  • The number of transplant procedures performed in Canada increased over 5 years, with 2,515 transplants performed in 2015, up from 2,116 in 2010.
  • There were 649 deceased organ donors and 563 living organ donors in 2015.
  • More than 4,500 Canadians were waiting for an organ transplant at the end of 2015. More than 200 people died waiting for a transplant.

For more data on organ replacement, please see Annual Statistics on Organ Replacement in Canada: Dialysis, Transplantation and Donation, 2006 to 2015.

About CIHI

CIHI collects and analyzes information on health and health care in Canada and makes it publicly available. Canada’s federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI’s goal: to provide timely, accurate and comparable health information. CIHI’s data and reports inform health policies, support the effective delivery of health services and raise awareness about the factors that contribute to good health and health care.

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