December 18, 2018 — New data from the Canadian Institute for Health Information (CIHI) highlights the significant difference between dialysis and transplant outcomes for those being treated for end-stage kidney disease (ESKD). A focused look at 10-year outcome data shows that 16% of Canadians on dialysis survive past 10 years, whereas up to 74% of Canadians with a kidney transplant still have a functioning kidney after 10 years. Outcomes for both kidney transplants and dialysis have been improving over the last decade.
Age, general health and the cause of ESKD are significant factors in determining outcomes. Younger patients can typically expect better outcomes than older patients, regardless of treatment type. According to the data,
- 51% of Canadians age 18 to 44 who start dialysis survive past 10 years, compared with 12% for those age 65 to 74.
- Up to 80% of Canadians age 18 to 44 have a functioning kidney 10 years after transplantation, compared with up to 64% for those older than 65.
- A kidney transplant from a living donor generally functions longer than one from a deceased donor.
Outcomes for transplant recipients refer to the survival of the transplanted organs, whereas dialysis outcomes refer to the survival rate of patients — an important distinction between the two. If or when transplanted organs start to fail, patients can still receive dialysis. For those on dialysis who depend on the therapy to survive, alternative treatment options are not available, and these individuals may not be eligible for a transplant or receive one on time.
Transplants give life
Donna Fleming, from Toronto, Ontario, was born with 1 functioning kidney and received a transplant in 1973 at age 16. Fleming received dialysis treatment before her transplant and, 45 years later, started nocturnal dialysis in May 2018, which requires her to stay overnight at a clinic 3 times a week to receive treatment.
“After having 45 years of very good health due to receiving a kidney transplant, going back on dialysis was one of the hardest things I ever had to do. Fortunately, we have dialysis to help keep us alive until another transplant comes along, however long that wait may be.” — Donna Fleming, kidney transplant recipient
Fleming is currently undergoing testing to determine whether her health is stable enough to receive a second transplant.
ESKD continues to rise in Canada
Over the last 10 years, the number of Canadians living with ESKD increased 35%, with more than 38,800 (excluding Quebec) living with the disease. In 2017, there were 1,771 kidney transplants performed in the country. At the end of the year, 3,253 Canadians were waiting for a kidney transplant.
“For Canadians living with end-stage kidney disease, a kidney transplant has several advantages. It means increased survival and significantly better quality of life than dialysis. From a health system perspective, kidney transplants can be more cost-effective than long-term dialysis. But the increasing number of Canadians in need of a new kidney and the shortage of organ donors in the country means that some patients never receive a transplant.” — Greg Webster, Director, Acute and Ambulatory Care Information Services, CIHI
Between 2008 and 2017, the rate of deceased organ donations increased 51%. The increase in deceased organ donations is a promising trend, especially considering that a deceased donor can donate up to 8 organs. However, CIHI data shows that, on average, kidneys from living donors typically function longer. Between 2008 and 2017, the rate of living donation — meaning donations such as a kidney or partial liver from a living person — decreased 11%.
Organ donations by the numbers
CIHI’s annual Canadian Organ Replacement Register release includes information on all donations for kidney, heart, lung, liver, pancreas and intestinal transplantations. The 2017 highlights include the following:
- 2,930 transplant procedures were performed — 95 more than the previous year.
- In 2017, there were 803 deceased organ donors in Canada — 43 more than in 2016. In addition, there were 535 living organ donors — 9 less than in 2016.
- Canada still has a shortage of organs, with 4,333 patients waiting for transplants.
- In 2017, 242 Canadians died while waiting for an organ transplant.
Canadian health systems rely on organ donations to help save lives of those in need. The release of CIHI’s organ donation data is an important reminder to all Canadians who wish to become donors to register to be an organ donor and to speak to your family about your wishes. Read up on how to become an organ donor.
The Canadian Institute for Health Information (CIHI) is an independent, not-for-profit organization that provides essential information on Canada’s health systems and the health of Canadians.
We provide comparable and actionable data and information that are used to accelerate improvements in health care, health system performance and population health across Canada. Our stakeholders use our broad range of health system databases, measurements and standards, together with our evidence-based reports and analyses, in their decision-making processes. We protect the privacy of Canadians by ensuring the confidentiality and integrity of the health care information we provide.