Ontario Renal Network | Reseau Renal de L'Ontario

Progression of CKD

ORN | Ontario Renal Network » Info for Patients » Progression of CKD

Chronic kidney disease (CKD) is caused by many diseases and disorders that affect the kidneys. Most diseases of the kidney attack the filtering units of the kidneys — the nephrons — and damage their ability to eliminate wastes and excess fluids from the body.

As Ontario’s population continues to grow and age, and the prevalence of diabetes and vascular disease increases, the prevalence of CKD is also projected to increase.

Often the loss of kidney function starts slowly and silently, and progresses over a number of years. Not everyone progresses to end stage renal disease , at which time renal replacement therapy (such as dialysis or kidney transplantation) is required. Other times, kidney failure occurs rapidly. Some, whose kidneys ultimately fail, may experience more than one type of renal replacement therapy during their lifetimes, including hemodialysis , peritoneal dialysis or transplantation. Others may choose to receive no renal replacement therapy.

I am well

Primary Care
  • Regular checkup by primary care provider
  • Education
  • Prevention of risk factors
  • A healthy diet, healthy lifestyle and adequate exercise may prevent type 2 diabetes, an important risk factor for CKD

I am at risk of having CKD

Primary Care
  • Screening
  • Education
  • CKD Prevention
  • People who have risk factors like diabetes, hypertension, a family history of CKD, aboriginal heritage, or who are 65 or older need to be screened for CKD.

I have been diagnosed with CKD

Primary Care
  • Diagnosis
  • Disease management (e.g., education, support, prevention of progression)

  • If my CKD progresses to end stage renal disease:
Specialty Care
  • Pre-dialysis care (renal replacement therapy consultation; modality choice; if dialysis — type; location choice; body access option, etc.)
  • About 1 in 4 patients initiating dialysis in Ontario have never seen a nephrologist (crash starts)
  • About 20% of pre-dialysis patients will have their CKD progress to end stage renal disease (ESRD)

My kidneys have failed and I want renal replacement therapy

Specialty Care
  • Renal replacement therapy (dialysis, transplantation)
  • Ongoing management
  • Approximately 10,000 people in Ontario are receiving dialysis; of these, 77% go to centres and 23% dialyze at home; of the 23% who dialyze at home, 17% undergo peritoneal dialysis and 6% hemodialysis
  • More than 1,000 people are on Ontario's kidney transplant waiting list. In 2012, 582 kidney transplants were performed in Ontario
  • 84% of Ontario's hemodialysis patients started their dialysis using the least optimal type of vascular access (catheter)

My kidneys have failed and I do not want renal replacement therapy

Palliative Care
  • Conservative care
  • Patient choice
  • Patients who choose conservative care may receive it at home or in facility