Chronic kidney disease must be recognized

Canada needs a strong plan of action to tackle chronic kidney disease.

Canada is facing a looming health crisis that remains largely unaddressed and invisible at the policy and health system level. More than four million Canadians live with chronic kidney disease (CKD) and 50,000 currently receive dialysis or are living with a transplant, both life-sustaining but burdensome treatments.

With no cure, CKD profoundly impacts quality of life, contributing to lost income, overall poor health, and uncertainty about the future. The implications of CKD extend far beyond patients and families. CKD is now the 11th leading cause of death in Canada and one of our most expensive chronic diseases. Health-care costs exceed $11.7 billion annually, with most expenses incurred in the later stages of the disease, particularly dialysis and transplantation.

By 2050, the total cost burden of CKD is projected to rise to $17.6 billion and an estimated 6.2 million Canadians will be affected, driven by an aging population and rising rates of diabetes and high blood pressure.

But Canada has an opportunity to change course. Earlier this year, the Kidney Foundation of Canada launched a national strategic framework for chronic kidney disease, Canada’s first unified roadmap to transform kidney care from a reactive, crisis-based system focused on kidney failure to one centred on prevention, early intervention, and better long-term outcomes.

With health ministers gathered in Winnipeg this week to discuss patient and system needs across the country, leaders of the Kidney Foundation of Canada will meet with federal members of Parliament from Winnipeg, along with Manitoba MLAs, to discuss how each level of government can support the framework to help to improve kidney care. This discussion is particularly important as provinces and territories call for increased, sustainable funding for health care that focuses on preventative and early intervention measures.

Earlier diagnosis, routine screening for people at risk, and timely access to effective therapies can delay or prevent kidney failure, improve quality of life, and reduce the need for dialysis and transplantation which cost our health system more in the long run. The Kidney Foundation of Canada looks forward to reviewing the main pillars of the framework, as follows:

• Prevention and early detection — As the federal government does not formally recognize CKD as a distinct chronic disease it’s not systematically tracked by the Public Health Agency of Canada. This is a costly mistake as CKD is often preventable and treatable if it’s caught early.

In particular, Canadians at higher risk, including those living with diabetes or hypertension, as well as racialized and Indigenous communities, should have access to routine screening and evidence-based care before irreversible damage occurs.

• Equitable access to kidney care — Indigenous peoples are three times more likely to develop CKD, and higher rates are also seen in Black, South Asian, and Southeast Asian communities. Addressing systemic barriers, expanding culturally safe care, and ensuring access to new therapies, particularly in the early stages of disease, must be central to any national strategy.

• Strengthening research and data for better kidney health — Without consistent surveillance, governments cannot accurately measure the burden of disease, plan services or invest strategically in prevention and early diagnosis. Compounding the problem, most people experience no symptoms until significant kidney damage has already occurred. By then, opportunities to slow or prevent progression have often been lost.

Canada is a global leader in kidney research, but better surveillance and co-ordinated data systems are essential to understand the disease, evaluate outcomes and prepare for growing demand.

This framework reflects the voices of those most affected by kidney disease. More than 740 people living with kidney disease shared their experiences through a national survey, and extensive collaboration with clinical experts, allied care providers, researchers, policymakers, and other experts across Canada took place through consultations and focus groups.

The federal government must act now to formally recognize CKD as a distinct chronic disease, adopt the national strategic framework as a roadmap for co-ordinated action, and strengthen surveillance and data systems to support evidence-based decision-making. Provinces and territories should also be prepared to take action to invest in improving kidney care.

The economic case is equally compelling as addressing this public health issue. Investing in prevention and early intervention reduces hospital admissions, emergency visits, and the need for costly dialysis and transplantation. It supports workforce participation and improves quality of life.

In short, smarter kidney policy is both good health policy and good economic policy. CKD may be a silent disease, but its consequences are impossible to ignore. Canada has the expertise, the evidence and now the roadmap. What we need is the political will to act.

Ignoring chronic kidney disease is no longer an option.

Carrie Thibodeau is national director of programs and public policy at the Kidney Foundation of Canada.