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Advanced Chronic Kidney Disease - System Performance Data

A small proportion of people with chronic kidney disease have disease that has advanced in severity, putting them at especially high risk of progressing to end-stage kidney disease. These people can be identified by testing their renal function and urine protein. Appropriate referral of these people to a multidisciplinary kidney care clinic is important to help them manage their condition and make the treatment choices that are best for them.

Referral to a Multi-Care Kidney Clinic

Results

In 2019/20, among new patients with advanced chronic kidney disease who were under the care of a nephrologist, 57.6% were referred to a multi-care kidney clinic. A provincial target of 70% for this indicator was implemented in 2020/21.

Why it matters

People with advanced chronic kidney disease who are progressing toward end-stage kidney disease need to make crucial, stressful and often complex decisions about their future course of care. This requires specialist multidisciplinary management and preparation for treatments such as dialysis, transplant or conservative care. This can be provided in clinics known as multi-care kidney clinics. Clinic staff include nephrologists, nurses, dietitians, social workers and pharmacists.

See Referral to a Multi-Care Kidney Clinic - Indicator Methodology for technical information.

Data Sources
Ontario Renal Reporting System, Ontario Lab Information System, Discharge Abstract Database, National Ambulatory Care Reporting System, Registered Persons Database, Ontario Health Insurance Plan Claims Database, Corporate Provider Database, Ontario Renal Network Nephrologist List

Percentage of new patients referred to a multi-care kidney clinic, among people with advanced chronic kidney disease who were under the care of a nephrologist, in Ontario, fiscal year 2014/15 to fiscal year 2019/20
Fiscal year Percentage of patients
FY2014/15 69.2%
FY2015/16 71.5%
FY2016/17 70.1%
FY2017/18 64.5%
FY2018/19 60.1%
FY2019/20 57.6%

Data Sources
Ontario Renal Reporting System, Ontario Lab Information System, Discharge Abstract Database, National Ambulatory Care Reporting System, Registered Persons Database, Ontario Health Insurance Plan Claims Database, Corporate Provider Database, Ontario Renal Network Nephrologist List

Improving care in Ontario

We are investigating the reasons patients are referred late or not at all to multi-care kidney clinics, and identifying provincial initiatives to improve access to and use of these clinics.

Time Spent in a Multi-Care Kidney Clinic Before Starting Dialysis

Results

Among people who started chronic dialysis in Ontario in the third quarter (Q3) of fiscal year 2020/21, 68.7% had received care from a multi-care kidney clinic for at least 12 months. That was an increase from 57.4% in Q3 of fiscal year 2015/16, but remained below the provincial target of 75% implemented in 2019/20.

Why it matters

Through analyses and expert consultations, we found improved clinical outcomes among patients who received care in a multi-care kidney clinic for at least 12 months before starting dialysis, suggesting that is a reasonable amount of multidisciplinary care and education to prepare for dialysis.

See Care in a Multi-Care Kidney Clinic Before Starting Dialysis - Indicator Methodology for technical information.

Data Sources
Ontario Renal Reporting System, Trillium Gift of Life Network

Percentage of people who had received care from a multi-care kidney clinic for at least 12 months, among those who started chronic kidney dialysis, in Ontario, Q3 fiscal year 2015/16 to Q3 fiscal year 2020/21
Fiscal quarter Percentage of patients
Q3 2015/16 57.4%
Q3 2016/17 62.4%
Q3 2017/18 66.7%
Q3 2018/19 66.6%
Q3 2019/20 68.8%
Q3 2020/21 68.7%

Data Sources
Ontario Renal Reporting System, Trillium Gift of Life Network

Improving care in Ontario

We are:

  • engaging with Regional Renal Programs and nephrologists to promote timely referrals to multi-care kidney clinics
  • launching a multi-care kidney clinic Community of Practice and a multi-indicator report to support Regional Renal Programs in improving access, quality of care and patient experience related to multi-care kidney clinics

Delaying the Start of Dialysis

Results

Among people who started chronic dialysis in the third quarter (Q3) of fiscal year 2020/21, 78.0% started at an appropriate stage of chronic kidney disease. This was up from 68.8% in Q3 of fiscal year 2015/16 and exceeded the provincial target of 75% introduced in 2016/17.

Why it matters

The evidence shows no association between an earlier dialysis start strategy and better outcomes or quality of life for people with end-stage kidney disease. A better strategy would be intent to defer the start of dialysis. For most people with chronic kidney disease, starting dialysis is considered appropriate when their estimated glomerular filtration rate (eGFR) is less than or equal to 9.5 mL/min/1.73m2. The eGFR is a measure of kidney function.

See Starting Dialysis at the Appropriate Stage of Kidney Disease - Indicator Methodology for technical information.

Data Sources
Ontario Renal Reporting System

Percentage of people, among all those who started chronic dialysis, who started with an eGFR less than or equal to 9.5 mL/min/1.73m2, in Ontario, Q3 fiscal year 2015/16 to Q3 fiscal year 2020/21
Fiscal quarter Percentage of patients
Q3 2015/16 68.8%
Q3 2016/17 69.5%
Q3 2017/18 72.5%
Q3 2018/19 74.2%
Q3 2019/20 76.2%
Q3 2020/21 78.0%

Data Sources
Ontario Renal Reporting System

Improving care in Ontario

To encourage use of a deferred dialysis strategy, we are:

  • sharing evidence for deferred dialysis with multi-care kidney clinic care teams
  • providing detailed reports to support local improvement initiatives

Acknowledgements

This analysis was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health. The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario Ministry of Health is intended or should be inferred. 

Parts of this material are based on data and information compiled and provided by Canadian Institute for Health Information. However, the analyses, conclusions, opinions and statements expressed on this page are those of the author, and not necessarily those of the Canadian Institute for Health Information. 

We acknowledge the support of the Ontario Ministry of Health. The views expressed in the report are those of the authors and do not necessarily reflect those of Ontario Ministry of Health. 

We acknowledge that data used in this publication were provided by the Trillium Gift of Life Network, Ontario Health, which is funded by the Government of Ontario. The analyses, conclusions, opinions and statements expressed in the material are those of the author(s), and not necessarily those of the Trillium Gift of Life Network.