Evaluating the impact of upstream and downstream interventions on chronic kidney disease and dialysis care: a simulation analysis

An ageing population, with increasing prevalence of diabetes and hypertension, is expected to increase the number of people with chronic kidney disease (CKD) and end-stage renal disease (ESRD) needing dialysis. This paper explores the impact of upstream and downstream interventions on the future number of CKD, ESRD patients needing dialysis, and the cost of dialysis. A system dynamics model was developed based on Singapore national data. Results indicate that under the base case scenario the number of people with CKD is projected to increase from 437,338 in 2020 to 489,049 by 2040. As a result, the number of patients requiring dialysis is projected to increase from 7669 in 2020 to 10,516 by 2040. The cost of dialysis care, under the base case, is projected to increase from S$417.08 million in 2020 to S$907.01 million by 2040. The policy experiments show that a combined policy will cumulatively save S$1.042 billion from 2020 to 2040.