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Dialysis – System Performance Data

Dialysis is a life-sustaining therapy needed by most people with end-stage renal disease. It replaces some of the functions normally performed by healthy kidneys.

In hemodialysis, the person’s blood passes through a machine that filters waste and toxins from it. In peritoneal dialysis, a cleansing fluid is passed through the person’s abdomen, where it is filtered through the lining of the belly to remove waste and toxins from the blood. Some people can have dialysis at home if they are medically suitable.

Learn more about dialysis.

Learn more about home dialysis.

People on Home Dialysis

Results

As of the fourth quarter (Q4) of fiscal year 2020/21, 26.0% of people on chronic dialysis in Ontario were on home dialysis. That was an increase from 22.2% in Q1 of fiscal year 2012/13, but below the provincial target of 27%.

Why it matters

Dialysis at home is usually better, as it gives people control over their dialysis schedule, requires less travel and works as well as dialysis in hospitals.

How Ontario compares

Among the provinces and territories, home dialysis prevalence among people on chronic dialysis in 2019 ranged from 10.3% in Newfoundland and Labrador to 29.1% in Alberta, Northwest Territories and Nunavut. Canada-wide, the rate was 25.1%.

Internationally, Canada had one of the highest rates of home dialysis in 2018, performing similarly to Colombia (27%) and Finland (26%) but well below the top-performing country, Hong Kong (72%).

See Patients on Home Dialysis - Indicator Methodology for technical information.

Data Source
Ontario Renal Reporting System

Percentage of patients on home dialysis among those who were on chronic dialysis, in Ontario, Q1 fiscal year 2012/13 to Q4 fiscal year 2020/21
Fiscal quarter Percentage of patients
Q1 2012/13 22.2%
Q1 2013/14 22.9%
Q1 2014/15 23.2%
Q1 2015/16 23.9%
Q1 2016/17 25.2%
Q1 2017/18 25.9%
Q1 2018/19 25.9%
Q1 2019/20 25.5%
Q1 2020/21 25.5%
Q4 2020/21 26.0%

Data Source
Ontario Renal Reporting System

Improving care in Ontario

To help increase the proportion of dialysis patients who are on home dialysis, we are:

  • providing detailed reports on how many patients are doing dialysis at home and reasons why people might not be
  • supporting a home dialysis mentorship program for Regional Renal Programs
  • funding programs such as personalized grants to help offset the person’s costs of doing hemodialysis at home

Wait Time for Priority 3 Vascular Access Surgery

Results

In the fourth quarter (Q4) of 2020/21, 72.6% of Priority 3 patients had their vascular access surgery within the 4-week provincial maximum wait time. This was below the provincial target of 80%. This wait time is measured from the date of the decision to proceed with the surgery. Priority 3 surgery involves semi-urgent cases, where a vascular access needs to be created for a person who is on hemodialysis or is expected to start within 6 months, or who has an access that needs to be remade.

Why it matters

A vascular access is an access point surgically created on the body where dialysis equipment can be connected to the person. This allows them to have life-sustaining hemodialysis. Reducing vascular access surgery wait times is critical for people to get fair access to high-quality care when they need it.

See Wait Time for Priority 3 Vascular Access Surgery - Indicator Methodology for technical information.

Data Source
Wait Times Information System

Percentage of patients who had their Priority 3 vascular access surgery completed within the target wait time, Q4 fiscal year 2015/16 to Q4 fiscal year 2020/21
Fiscal quarter Percentage of patients
Q4 2015/16 74.1%
Q4 2016/17 77.2%
Q4 2017/18 75.4%
Q4 2018/19 83.1%
Q4 2019/20 83.7%
Q4 2020/21 72.6%

Data Source
Wait Times Information System

Improving care in Ontario

Where needed, we support Regional Renal Programs by advocating for dialysis access surgeries to be prioritized and considered urgent for life-sustaining treatment.

We also monitor but do not report on wait times for Priority 2 surgeries, which are urgent but few, and Priority 4 surgeries, which are elective and nearly all completed within the 26-week maximum wait target. The maximum wait target is 2 weeks for priority 2 surgeries. Priority 1 access surgeries are emergency surgeries that must be performed within 24 hours.

Dialysis-Related Infection Rates

Results

People on dialysis are at increased risk of infection because they have to regularly connect to a dialysis machine through a body access, such as a catheter. Here we report on 2 types of dialysis-related infection: peritonitis and catheter-related bacteremia.

Peritonitis

Peritonitis is inflammation of the tissue that lines the inner wall of the abdomen.

In the fourth quarter (Q4) of fiscal year 2020/21, there were 0.20 cases of peritonitis for every year of peritoneal dialysis received collectively by people with chronic kidney disease in Ontario. That is fewer than the benchmark of 0.50 cases per patient year set by the International Society of Peritoneal Dialysis.

Catheter-related bacteremia

Catheter-related bacteremia is bloodstream infection from an intravenous catheter (the tube inserted into a person’s vein for dialysis).

In the fourth quarter (Q4) of fiscal year 2020/21, there were 0.20 cases of catheter-related bacteremia for every 1,000 days of hemodialysis received collectively by people with chronic kidney disease in Ontario. Though there is no international benchmark, medical experts have identified this rate in Ontario to be low.

Why it matters

Peritonitis and catheter-related bacteremia are potentially serious complications of dialysis. Reducing their frequency is an important component of improving the quality of care patients receive.

Data Source
Ontario Renal Reporting System

Cases of peritonitis reported per year of peritoneal dialysis received collectively by people with chronic kidney disease, in Ontario, by quarter, Q4 fiscal year 2016/17 to Q4 fiscal
Fiscal quarter Cases per year
Q4 2016/17 0.25
Q4 2017/18 0.21
Q4 2018/19 0.21
Q4 2019/20 0.23
Q4 2020/21 0.20

Data Source
Ontario Renal Reporting System

See Infection Rates - Indicator Methodology for technical information.

Data Source
Ontario Renal Reporting System

Cases of catheter-related bacteremia reported per 1,000 days of in-centre hemodialysis received collectively by people with chronic kidney disease, in Ontario, by quarter, Q4 fiscal year 2016/17 to Q4 fiscal year 2020/21
Fiscal quarter Cases per 1,000 days
Q4 2016/17 0.19
Q4 2017/18 0.20
Q4 2018/19 0.20
Q4 2019/20 0.23
Q4 2020/21 0.20

Data Source
Ontario Renal Reporting System

Improving care in Ontario

We monitor monthly and quarterly rates of peritonitis and catheter-related bacteremia, in the province as a whole and by Regional Renal Program. We share the data regularly with Regional Renal Programs to support quality improvement efforts.

Goals of Care Conversations

Results

In the third quarter (Q3) of fiscal year 2020/21, 40.5% of people on chronic dialysis had a documented Goals of Care conversation with a healthcare provider within 90 days of starting dialysis. This was below the provincial target of 70% implemented in Q4 of fiscal year 2019/20.

Why it matters

Goals of Care conversations help ensure treatment decisions align with patients’ wishes, values and beliefs. It is important to introduce Goals of Care conversations early and review goals regularly throughout the patient journey. Goals of Care conversations should be completed within 90 days of starting chronic dialysis.

See Goals of Care - Indicator Methodology for technical information.

Data Sources
Ontario Renal Reporting System, Person-Centred Decision-Making Manual Collection Tool

Percentage of people on chronic dialysis who had a documented Goals of Care conversation with a healthcare provider within 90 days of starting dialysis, Q4 fiscal year 2018/19 to Q3 fiscal year 2020/21
Fiscal quarter Percentage of patients
Q4 2018/19 49.3%
Q1 2019/20 48.4%
Q2 2019/20 45.5%
Q3 2019/20 44.2%
Q4 2019/20 40.7%
Q1 2020/21 39.2%
Q2 2020/21 40.0%
Q3 2020/21 40.5%

Data Sources
Ontario Renal Reporting System, Person-Centred Decision-Making Manual Collection Tool

Improving care in Ontario

We support renal care teams by providing detailed reports on the occurrence and timing of their Goals of Care conversations with patients. These reports aim to increase team engagement in and prioritization of Goals of Care conversations as part of patient care.