System dynamics facilitate complex decision-making for healthcare delivery: A case study of chronic kidney disease in Wales
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We predicted the future prevalence of CKD in Wales, with a focus on ESKD and its treatment modalities.
Abstract: Global healthcare systems face rising costs and increasingly complex choices for decision-makers, making it crucial to fully understand treatment value. Here, a systems dynamics approach allowed the Welsh NHS to evaluate the overall burden of chronic kidney disease (CKD) and understand the short- and long-term impacts of current treatment guidelines on future prevalence, to ensure treatment capacity in the future.
An age- and CKD stage-stratified system dynamics model of Welsh CKD prevalence was developed, with age-dependent migration and mortality rates. It was calibrated against observed prevalence data from 2000 to 2020 and used to predict prevalence up to 2044.
Welsh CKD prevalence is predicted to rise from 208,000 in 2024 to 234,000 by 2034. Prevalence of end-stage kidney disease (ESKD) is predicted to rise from 3,448 in 2024 to 4,002 by 2034. Treatment optimisation is predicted to further increase CKD prevalence whilst marginally reducing ESKD. This is explained by the interplay between slowing of CKD progression and reductions in mortality rates, meaning people have longer to progress to later CKD stages . Across Wales, existing dialysis centre capacity was found to be sufficient up to 2044.
Using systems dynamics to model the Welsh CKD population revealed future interplay between optimised treatment implementation and prevalence of ESKD, allowing informed decision making on future treatment (dialysis) capacity.
Lay abstract: This study predicts the number of people with chronic kidney disease in Wales with a focus on patients with end stage kidney disease. This is used to determine the required capacity to deliver dialysis in Wales in the future.
Recommended citation: Padgett, T., McEwan, P. (2025) System dynamics facilitate complex decision-making for healthcare delivery: A case study of chronic kidney disease in Wales. EURO2025, 23 June 2025; Presentation.