Mendelssohn D C, Chery A
Toronto Hospital, Ont.
CMAJ. 1994 Apr 1;150(7):1099-105.
To analyse trends in the demand for and supply of dialysis in the Toronto region and to determine whether planned dialysis expansion will be sufficient to provide for the projected growth of the dialysis population.
Descriptive analysis of data reported to the Toronto Region Dialysis Registry between 1981 and 1992, compared with provincial and national equivalents.
All secondary and tertiary care dialysis programs in the Toronto region participating in the registry.
All 504 existing patients enrolled in dialysis programs in 1981 and all 3794 new patients entering programs from 1982 to 1992. Patients with acute renal failure were excluded.
Demand for dialysis: dialysis population at year end, age distribution, crude mortality rate and transplant rate. Supply of resources: distribution of modality (hemodialysis or peritoneal dialysis), number of patients treated per hemodialysis station, number of hemodialysis stations per million population and hemodialysis utilization index (actual/budgeted treatments).
During the study period the number of dialysis patients in the Toronto region went from 504 to 1422, for an increase of 182.1%. The average rate of growth was 9.8% per year. Of the total increment of 918 patients from 1981 to 1992, 390 (42.5%) were 65 years of age or more; none the less, the average annual crude mortality rate remained relatively constant, at 13.8% to 17.3%. The transplantation rate declined from a peak of 20.2% in 1982 to 7.8% in 1992. During the study period the Toronto region had much higher numbers of dialysis patients, and hemodialysis patients, per hemodialysis station than the rest of Ontario or Canada. The region's hemodialysis utilization index was 101% in 1991 and 102% in 1992; the index in individual hospitals varied from 98% to 124% (85% was considered optimal).
The growth of the dialysis population in the Toronto region has caused a critical shortage of resources. This trend can be attributed mainly to a decrease in the transplantation rate and an increase in the number of elderly patients entering dialysis programs, combined with insufficient funding for expansion of facilities. Continuation of this trend would be expected to limit universal access to this expensive, but life-sustaining therapy.
分析多伦多地区透析的需求和供应趋势，并确定计划中的透析扩展是否足以满足透析人群预计的增长需求。
对1981年至1992年向多伦多地区透析登记处报告的数据进行描述性分析，并与省级和全国的数据进行比较。
多伦多地区所有参与登记处的二级和三级护理透析项目。
1981年登记在透析项目中的所有504名现有患者以及1982年至1992年进入项目的所有3794名新患者。排除急性肾衰竭患者。
透析需求：年末透析人群、年龄分布、粗死亡率和移植率。资源供应：透析方式（血液透析或腹膜透析）分布、每个血液透析站治疗的患者数量、每百万人口的血液透析站数量以及血液透析利用指数（实际/预算治疗量）。
在研究期间，多伦多地区的透析患者数量从504人增加到1422人，增长了182.1%。平均年增长率为9.8%。在1981年至1992年增加的918名患者中，390名（42.5%）年龄在65岁及以上；尽管如此，平均年粗死亡率仍相对稳定，在13.8%至17.3%之间。移植率从1982年的峰值20.2%下降到1992年的7.8%。在研究期间，多伦多地区每个血液透析站的透析患者和血液透析患者数量比安大略省其他地区或加拿大其他地区多得多。该地区的血液透析利用指数在1991年为101%，在1992年为102%；各医院的指数从98%到124%不等（85%被认为是最佳值）。
多伦多地区透析人群的增长导致了资源的严重短缺。这种趋势主要可归因于移植率的下降和进入透析项目的老年患者数量的增加，以及设施扩展资金不足。预计这种趋势的持续将限制人们普遍获得这种昂贵但维持生命的治疗方法。
