Dr. Anukul Ghimire

Supervisor(s): Dr. Joseph Kim
Award: KRESCENT Post-Doctoral Fellowship
Institution: University Health Network
Year: 2026-2029
Project Title: The changing landscape of people with kidney disease: What does this mean for patients and our health system?
Topic(s): Transplantation

Biography

Anukul Ghimire completed his M.D and Internal Medicine residency at the University of Alberta. This was followed by Nephrology training at the University of Calgary, and a fellowship in Solid Organ Transplantation at the University Health Network in Toronto. He is currently a PhD student in the Clinical Epidemiology and Health Care Research program at the University of Toronto. He is interested in understanding how changes in the epidemiology of people with kidney disease are impacting outcomes and healthcare utilization in transplantation programs.

Lay Summary

Background: Canadians are living longer because of improvements in medical care and health policy. In kidney care, new treatments that slow the progression of kidney disease may lead to more people reaching kidney failure later in life. As a result, there is an increase in those who have more chronic and complex conditions than in the past. For people with kidney failure, there are two life-saving treatments: dialysis and kidney transplantation. Transplantation (compared to dialysis) is thought to be associated with greater patient survival, better quality of life, and lower long-term health care costs. However, these benefits may be changing over time as people’s health conditions become more complex.

Purpose: The goal of this study is to provide an up-to-date assessment of how characteristics (such as age and being diagnosed with different chronic conditions), health outcomes (such as survival), and healthcare spending have changed over time for people with kidney disease. We will compare these trends among people with kidney disease not needing dialysis, people treated with dialysis, and people who received a kidney transplant. In the context of Canada’s publicly funded healthcare system, this information can be used to guide health policy and support decisions about how to use limited resources effectively.

Methods: This study will use healthcare databases from Ontario, Canada, being managed by the Institute for Clinical Evaluative Sciences. Information will be collected on patient demographics, socioeconomic status, medical conditions, health outcomes, and healthcare spending for people diagnosed with kidney disease between 1994 and 2025. We will compare how the following have changed over time for people with kidney disease not needing dialysis, people treated with dialysis, and people who receive a kidney transplant: (1) number and types of chronic conditions, (2) patient survival, (3) number of hospitalizations, and (4) projected costs to the provincial health system.

We will also examine differences in health outcomes and healthcare costs for patients of different socioeconomic status, sex, and age categories.

Anticipated Outcomes: We predict that people with kidney failure have become older and have more chronic illnesses than in the past. Because of this, transplant patients may now be more medically complex and may experience more hospitalizations related to medical and surgical complications from the transplant. In turn, the health care costs associated with transplantation may have increased over time. Despite these challenges we expect that, overall, people with kidney failure have improved medical outcomes due to advances in care.

Patient Engagement: We intend to recruit patient partners through the patient partner networks at the Toronto General Hospital Transplant and Dialysis Program. These partners, whether patients or family members, bring valuable lived experience with kidney disease and can offer important perspectives on health outcomes and quality of life. They will help interpret the quantitative results by adding narrative context. We will also seek their views on how our findings can support more effective patient counselling and shared decision-making during discussions about transplantation.

Relevance to Patients/Community: This study will provide up-to-date information on patient outcomes and healthcare spending for patients receiving dialysis and transplantation. These data, when integrated into patient counselling, will help patients understand the benefits and risks of each treatment option. From a societal view, this work can help guide health policy decisions. For example, if more hospitalizations after transplantation are leading to much higher healthcare costs, then this may signal the need for more specialized outpatient units to proactively care for patients to help prevent hospital admissions. The findings may also signal the need to shift medical education and workforce allocation to care for a changing population of patients.

Conclusion: Medical advances and health policy changes have greatly affected the type of patients cared for by kidney physicians. This study will describe how patient profiles, health outcomes, and healthcare spending have evolved over time. In a publicly funded healthcare system with limited resources, these data can be used to shape health policy and support the delivery of more sustainable healthcare services. It can also help patients make more informed decisions about their treatment.