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.
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 2021/22, 69.4% had received care from a multi-care kidney clinic for at least 12 months. That was an increase from 62.4% in Q3 of fiscal year 2016/17, 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.
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 2021/22, 75.4% started at an appropriate stage of chronic kidney disease. This was up from 69.6% in Q3 of fiscal year 2016/17 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.
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
Data used in this publication is from the Ontario Renal Reporting System, managed by the Ontario Renal Network, a business unit of Ontario Health.
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.