Predicting the future demand for renal replacement therapy in England using simulation modelling

Background. The purpose of the study was to estimate the future demand for renal replacement therapy in England. Simulation modelling was used to estimate the future demand, under varying assumptions, about the growth in the acceptance rate for renal replacement therapy, patient and treatment survival, and the availability of kidney transplants. Methods. Data were obtained from the National Renal Review, the European Dialysis and Transplant Registry, and the United Kingdom Transplant Support Services Authority. They were analysed to provide transfer and survival data on patients treated for endstage renal failure in England and in four exemplary district health authorities. The simulation runs provided estimates of numbers of patients being treated by dialysis and transplantation over the next 15 years. Results. The results indicated that the number under treatment was predicted to rise by between 50 and 100% over the next 15 years, with a disproportionate increase in dialysis of up to 150%. There will be more 'high-risk elderly' people under treatment, particularly amongst the dialysis patients. The growth in numbers will vary between districts depending on their level of need and current service position. Conclusion. There will be increasing numbers of patients, particularly elderly patients with associated comorbidity, receiving treatment. Given the shortage of kidneys for transplantation, the demand will fall on haemodialysis and continuous ambulatory peritoneal dialysis facilities. Purchasers are thus faced with steeply rising costs for this patient group, especially in areas of high need, whilst needing to find improvements in their quality of care.