Use our statistics to help plan for the future

Unfortunately, I work in a growth industry: renal disease causing renal failure has shown a steady increase of between five and eight percent annually since 1980 in Canada.

Diabetes and hypertension are the major causes of kidney failure in Canada. As our population ages and becomes more obese, the incidence of these diseases increases and so, too, does the need for treatment with dialysis and/or kidney transplantation.

The development of the new McGill University Health Centre (MUHC) facility is giving us the opportunity to take stock of our current medical paradigm so that we can accommodate these growing numbers of patients.

In 1999 Canada had over 22,000 patients on dialysis or with a kidney transplant. This compares to 5,500 in 1981 and that number is increasing all the time. At the Royal Victoria Hospital (RVH) campus, we had 30 hemodialysis patients in 1975 and today we have almost 200 patients on hemodialysis and peritoneal dialysis. In our wildest imaginings, we never anticipated these figures.

Fortunately, our data collection in this area has been complete and allows us to anticipate our future needs. We have been tracking information for more than 20 years. We know who in the population is developing kidney disease and from what cause. We know what type of treatments are being administered, to how many people and for how long. Consequently, over the past two decades we have been able to project very accurately what the health care burden would be in this field. We expect that our statistics for the next decade will be equally accurate. Our predictions tell us that there is no way the structures we have today can continue to accommodate our programs.

Today, the physical plant at the RVH is challenged. Extra supplies are piled up in the halls, empty stretchers are stuffed in between the treatment chairs and the paint on the walls is peeling. The garbage cans, overflowing with disposable blood lines, are interspersed between patient chairs. Our ventilation system is suboptimal. The crowding is simply unfair to our patients and our staff.

Is this the atmosphere where you would like to spend hours of your week if you were on dialysis? Is this a work environment you would choose?

No, neither would I, and yet these are the conditions in which our patients are currently treated. So, when I am asked if I look forward to new treatment facilities where there can be more dignity, privacy and comfort for health-care recipients, I say yes.

You've heard the argument before; when our current buildings were constructed, medicine as we know it today did not exist. Therefore, spaces designed for the medical realities of fifty years ago - when dialysis wasn't even an option - are currently obsolete. At our Montreal General campus, we have recently upgraded the dialysis unit to a state-of-the-art facility. But at present growth rates, even there, we will only be able to accommodate the demand for the next two to four years.

Certainly not all of our problems should be solved by bricks and mortar at a single MUHC site.

Perhaps there needs to be a greater network of satellite dialysis units in the community so that patients do not need to come to a hospital site. How exactly will that model be developed? How will we assure access to hospital-based facilities, physicians and technology? What would be the teaching implications?

One of our ongoing goals must be to engage the community. Perhaps because this is such a rapidly developing field, the general public has not quite realized its attending issues and urgency. We must be proactive and energetic about increasing awareness of kidney disease and fundraising to support research in the area. Have you filled out your organ donor card yet?

In Quebec, we have a large investment in both dialysis programs - hemodialysis (visiting the hospital three times a week for four hour treatments) and peritoneal dialysis (daily or overnight home-based treatments). These regimes are expensive and costs to the health care system are between $60,000 - $85,000 per patient per year (this figure includes dialysis and other hospital costs such as x-rays, lab test, surgeries, etc.). The procedures are physically and psychologically draining. While we may not be able to substantially reduce the financial costs in a new building, we can upgrade the environment.

In this regard, the new facility has the potential to improve the lives of kidney patients and our staff substantially.

Current dialysis patients are able to benefit from some of the latest technological advances in the field of medicine. I hope the MUHC can meet the challenges it faces in matching those forward strides by improving the patient and staff surroundings. My patients rarely complain and are thankful for the dedicated care they receive, even if it does feel somewhat chaotic at times. The staff are remarkably committed, skilled and compassionate. But I know how much they would benefit from better conditions. I am a strong advocate for change on their behalf.

Published by the MUHC Foundation in The Gazette