It was in 1998, that the Manitoba Provincial Dialysis Program was mandated by Manitoba Health (under the umbrella of the Winnipeg Regional Health Authority) to provide care for all adult patients receiving dialysis therapies in Manitoba.

While many dialysis units had been operating independently within their own facilities, there was inevitably collaboration between all units throughout the province. To facilitate more standardized care and smoother transitions for renal patients throughout the province, the overarching dialysis program was created. In 2002, the program’s name changed to Manitoba Renal Program (MRP).

“Kidney disease affects many Manitobans, regardless of where they live. A coordinated approach to kidney health care makes patient needs the priority,” explains Dr. Mauro Verrelli, MRP Medical Director.

The vision of the program included creating a uniform standard of high quality care, providing equitable access to all therapies and resources, developing outreach and prevention initiatives and building a provincial renal database in addition to planning dialysis expansions according to patient population growth.

There has been no shortage of need for dialysis services over the last 20 years. In 1999 the program was serving about 741 home and in-centre dialysis patients throughout the province. That number has grown to more than 1,700 in 2018. For in-centre patients alone, the program runs about 4,000 dialysis treatments a week or about 16,000 hours of dialysis.

“With new patients entering our program continuously, it’s important to be able to give the best care possible while simultaneously working on getting them back home or as close to home as possible.”

The program has worked with regional health authorities, the Manitoba government, communities and other stakeholders to keep up with the growing demand for dialysis services. Since 1998, eight new dialysis units have been built. These includes expansions in major hospitals and new units in rural areas. During this time other units also expanded their capacity. There are currently four major centres providing dialysis through multiple units in their facilities and an additional 16 local renal health centres throughout Manitoba. The most northern unit is located in Thompson. Since 1998 the rural renal health centre patient population has grown from 70 people to nearly 300.

Another area of growth over the last 20 years has been the expansion of home dialysis programs. Home hemodialysis programs were added during the last ten years while additional peritoneal dialysis (PD) programs were also developed. The home dialysis patient population has grown from 198 in 1999 to 391 in 2018.

Manitoba Renal Program also cares for patients with varying stages of kidney disease who are not on dialysis. These kidney health clinics are located in Winnipeg, Brandon and Thompson. Alongside the introduction of eGFR (estimated Glomerular Filtration Rate) reporting on standard lab results, primary care outreach, and growing rates of kidney disease, MRP has seen an increase in referrals over the last six years. This amounts to about 1,000 more early stage kidney disease patients today than in 2012. Currently, the interdisciplinary clinics manage more than more than 5,400 people who have stages one to five kidney disease.

Unfortunately the growth of these patient populations in unlikely to slow down any time soon.

Diabetes and high blood pressure are the leading causes of kidney disease in Canada. Manitoba has some of the highest rates of end-stage kidney disease in Canada and sees annual growth in the number of dialysis patients.

The program has partnered with several researchers on projects that aim to bring more early diagnosis and opportunities for treatment to all areas of Manitoba, including rural and remote regions.

“We are always focused on providing the highest quality care to our dialysis patients, but at the same time we want to see less people needing dialysis and partner wherever possible on screening initiatives that can help with preventing or delaying the progression of kidney disease,” says Dr. Verrelli.

The program also continues to adopt new, innovative technology that makes home dialysis an option for more people. Technology, accessibility and prevention will be key areas of focus over the coming years.

“There is a lot of innovation happening, from dialysis equipment to models of prediction to improve the timing of kidney disease interventions,” explains Dr. Verrelli.

 “The global community of kidney health care providers has really come together to share information and look for better ways to provide care and the renal program is proud to be working alongside them.”