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Australian Indigenous HealthBulletin
 

Kidney health (renal disease)

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Kidney health (renal disease)

Kidney disease, renal and urologic disease, and renal disorder are terms that refer to a variety of different disease processes involving damage to the working units of the kidneys and associated structures [1][2]. Of particular importance to Aboriginal and Torres Strait Islander people is chronic kidney disease (CKD), which is defined as kidney damage or reduced kidney function that lasts for three months or more [3]. CKD is inclusive of different conditions, including diabetic nephropathy, hypertensive renal disease, glomerular disease, chronic renal failure, and end-stage renal disease (ESRD) [4]. If left untreated, kidney function can decrease to the point where kidney replacement therapy, in the form of dialysis (mechanical filtering of the blood to help maintain functions normally performed by the kidneys) or transplantation (implantation of a kidney from either a living or recently deceased donor) is necessary to avoid death [3]. ESRD is expensive to treat and has a marked impact on the quality of life of those who suffer from the disease as well as those who care for them [5][6].

A number of risk factors are associated with kidney disease, including diabetes, high blood pressure, infections, LBW, and obesity [3]. These conditions are particularly common among Indigenous people and contribute to high rates of CKD [3][7].

Extent of kidney disease among Indigenous people
Prevalence

Around 1.8% of Indigenous people reported that they had kidney disease as a long-term health condition in the 2012-2013 AATSIHS [8]. After age-adjustment, the prevalence of kidney disease as a long-term health condition was 3.7 times higher for Indigenous people than for non-Indigenous people. The proportions of Indigenous people reporting kidney disease were similar for males and females, but the age-adjusted Indigenous:non-Indigenous prevalence ratio was slightly higher for males (3.9) than for females (3.6). The reported prevalence of kidney disease was less than 2% for Indigenous people aged less than 45 years, but 4.0% for those aged 45-54 years and 7.7% for those aged 55 years and over.

With most information on CKD limited to self-reported data, the primary focus in the literature has been on ESRD [3][9]. The overall incidence rate of ESRD for Indigenous people is consistently reported as being significantly higher than that for non-Indigenous people [9].

Data from the ANZDATA for the five-year period 2009-2013 reveal that the age-standardised notification rate of ESRD for Indigenous people was 579 per 1,000,000 population, 6.2 times the rate for non-Indigenous people (Table 25) (Derived from [10][11][12][13]).

Notification rates of ESRD were higher for Indigenous people than for non-Indigenous people in all states and territories, with the highest rates recorded for Indigenous people living in the NT (1,501 per 1,000,000), WA (922 per 1,000,000), and SA (696 per 1,000,000).

Table 25: Numbers of notifications and age-standardised notification rates for end-stage renal disease, by Indigenous status, and Indigenous:non-Indigenous rate ratios, selected jurisdictions, Australia, 2009-2013
JurisdictionIndigenousNon-IndigenousRate ratio
NumberRateNumberRate
Source: Derived from ANZDATA, 2014 [11], ABS, 2011 [12], ABS, 2003 [13], ABS, 2014 [10]
Notes:
  1. Rates per 1,000,000 population have been standardised using the ERP from 30 June 2001
  2. Rate ratio is the Indigenous rate divided by the non-Indigenous rate
  3. Notification rates for Tas and the ACT have not been shown separately because of the small numbers of notifications, but are included in the figures for Australia
NSW 169 288 3,707 94 3.1
Vic 55 387 2,957 98 3.9
Qld 287 510 2,072 89 5.7
WA 236 922 1,054 90 10.2
SA 76 696 865 91 7.6
NT 337 1,501 65 88 17.1
Australia 1,172 579 11,222 94 6.2

Of people newly registered with the ANZDATA in 2009-2015, 60% of Indigenous people were aged less than 55 years, compared with 30% of non-Indigenous people. Notification rates were higher for Indigenous people than for non-Indigenous people across all age-groups (except for the 0-14 years age-group) (Table 26) (Derived from [10][11][12][13]). Rate ratios were particularly high for people aged 45-54 years (11.6). Table 26. Numbers of notifications and notification rates of end-stage renal disease, by Indigenous status and age-group, and Indigenous:non-Indigenous rate ratios, Australia, 2009-2013

Table 26: Numbers of notifications and notification rates of end-stage renal disease, by Indigenous status and age-group, and Indigenous:non-Indigenous rate ratios, Australia, 2009-2013
Age-group (years)IndigenousNon-IndigenousRate ratio
NumberRateNumberRate
Source: Derived from ANZDATA, 2014 [11], ABS, 2011[12], ABS, 2003 [13], ABS, 2014 [10]
Notes:
  1. Rates per 1,000,000 population
  2. Rate ratio is the Indigenous rate divided by the non-Indigenous rate
  3. Rates for ‘All ages’ are age-standardised
0-14 7 6 169 8 0.8
15-24 24 36 265 18 2.0
25-34 66 145 517 33 4.4
35-44 228 557 890 57 9.8
45-54 381 1,210 1,560 104 11.6
55-64 334 1,818 2,447 191 9.5
65-74 114 1,457 2,801 336 4.3
75+ 18 512 2,573 364 1.4
All ages 1,172 579 11,222 94 6.2

Detailed information from ANZDATA is available for 2012 when a total of 254 Indigenous people commenced dialysis, representing a slight increase from 2011 [9]. In 2012, there were 20 new transplant operations for Indigenous recipients, compared with 801 operations performed for non-Indigenous recipients. At 31 December 2012, 34 (3%) of the 1,065 patients on the waiting list for a transplantation were Indigenous [14].

Haemodialysis (HD), conducted in urban or regional clinics and hospitals, is the most common form of dialysis treatment for Indigenous people with ESRD [3][15][16][17]. In 2012, HD accounted for the majority of treatment (90%), with only 10% of Indigenous dialysis patients receiving peritoneal dialysis (PD) [9]. The majority of non-Indigenous dialysis patients also received HD [15], but 19% of non-Indigenous dialysis patients received PD [18]. In 2012, there were 1,425 prevalent dialysis patients in Australia (including both PD and HD) identified as Indigenous, with a level 4.8 times higher for Indigenous people (2,430 per 1,000,000) than for non-Indigenous people (507 per 1,000,000) [9][19].

Hospitalisation

In 2012-13 hospitalisation rates for CKD were nearly 5 times higher among Indigenous people than for non-Indigenous people where CKD was the principal and/or additional diagnosis (excluding regular dialysis) [20]. For Indigenous males, rates were 3.4 times higher than for non-Indigenous males for hospitalisation for CKD as the principal and/or an additional diagnosis (4,340 and 1,269 per 100,000 respectively). For Indigenous females, rates were 6.3 times higher than for non-Indigenous females for hospitalisation for CKD as the principal and/or an additional diagnosis (5,157 and 817 per 100,000 respectively).

There were 172,151 hospital separations for ESRD among Indigenous people in 2012-13 [21]. After age-adjustment, the hospitalisation rate for ESRD was 9.9 times higher for Indigenous people than for other Australians. Indigenous females had the highest rate of hospitalisation for ESRD, 15.1 times that of other females; Indigenous males were hospitalised for ESRD, at 6.7 times the rate of other males.32 Contributing factors to the higher rates for Indigenous females include the higher prevalence of type 2 diabetes among Indigenous women and the large proportion of Indigenous women carrying high levels of body fat around their abdomen; both factors place them at higher risk for CKD [22].

In 2012-13 after age-adjustment, hospitalisation rates for ESRD for Indigenous people increased with remoteness [21]. In remote and very remote areas the hospitalisation rate for Indigenous people was over 50 times higher than for non-Indigenous people. For Indigenous people living in remote and very remote areas, the hospitalisation rate was over twice the rate of Indigenous people living in major cities.

In 2012-13, there were 1,038 hospital separations per 1,000 population for Indigenous people, 2.7 times the rate for non-Indigenous people with about 86% of the difference between these rates due to higher separation rates for Indigenous people admitted for same-day maintenance kidney dialysis [23]. Hospitalisation rates for regular dialysis as the principal diagnosis were 10 times higher for Indigenous people than for non-Indigenous people [20]. For Indigenous males, hospitalisation rates were 6.8 times higher than for non-Indigenous males for regular dialysis (39,268 and 5,805 per 100,000 respectively). For Indigenous females, hospitalisation rates were 14.9 times higher than for non-Indigenous females for regular dialysis (49,011 and 3,281 per 100,000 respectively).

Mortality

There were 63 deaths from disease of the urinary system among Indigenous people living in NSW, Qld, WA, SA and the NT in 2012, accounting for 2.6% of all Indigenous deaths in those jurisdictions [24].33 After age-adjustment, the death rate for Indigenous people was 2.5 times that for non-Indigenous people.

During the period 2008-2012, after adjusting for differences in population structure, the death rates for kidney disease for Indigenous people living in NSW, Qld, WA, SA and NT was 2.6 times (30 per 100,000) the rate for non-Indigenous people (11 per 100,000) [21].

More detailed information is available for people living in NSW, Qld, WA, SA and the NT for 2009-2011. During this period, CKD was the underlying or associated cause of death of 801 Indigenous people [25]. CKD was recorded as the underlying cause of death for 46% (371) of the 801 deaths of Indigenous people. After age-adjustment, the death rate for CKD as an underlying or associated cause of death for Indigenous people was 2.4 times higher than the rate for non-Indigenous people. The Indigenous:non-Indigenous rate ratios were higher for females (2.8) than for males (2.1). When CKD was the underlying cause of death, the death rate for Indigenous people was 2.8 times higher than for non-Indigenous people (35 and 12 per 100,000). The Indigenous:non-Indigenous rate ratios were higher for Indigenous females (3.4) than for Indigenous males (2.2).

References

  1. National Kidney and Urologic Diseases Information Clearinghouse (2014) The kidneys and how they work. Retrieved 2014 from http://kidney.niddk.nih.gov/kudiseases/pubs/yourkidneys/
  2. Kidney Health Australia (2014) What is kidney disease?. Retrieved 2014 from http://www.kidney.org.au/kidneydisease/tabid/578/default.aspx
  3. Australian Institute of Health and Welfare (2011) Chronic kidney disease in Aboriginal and Torres Strait Islander people 2011. Canberra: Australian Institute of Health and Welfare
  4. Australian Bureau of Statistics, Australian Institute of Health and Welfare (2008) The health and welfare of Australia's Aboriginal and Torres Strait Islander Peoples 2008. Canberra: Australian Bureau of Statistics and Australian Institute of Health and Welfare
  5. Kidney Health Australia (2010) The economic impact of end-stage kidney disease in Australia - projections to 2020. Melbourne: Kidney Health Australia
  6. Kidney Health Australia (2014) Fast facts on CKD in Australia. Retrieved 2014 from http://www.kidney.org.au/KidneyDisease/FastFactsonCKD/tabid/589/Default.aspx
  7. Steering Committee for the Review of Government Service Provision (2011) Report on government services 2011: Indigenous compendium. Canberra: Productivity Commission
  8. Australian Bureau of Statistics (2014) Australian Aboriginal and Torres Strait Islander health survey: updated results, 2012–13. Canberra: Australian Bureau of Statistics
  9. McDonald S, Jose M, Hurst K (2013) End-stage kidney disease among Indigenous peoples of Australia and New Zealand. In: Australia and New Zealand Dialysis and Transplant Registry, ed. The thirty sixth annual Australia and New Zealand Dialysis and Transplant Registry report 2013. Adelaide: Australia and New Zealand Dialysis and Transplant Registry: 12.1 - 12.20
  10. Australian Bureau of Statistics (2014) Estimates and projections, Aboriginal and Torres Strait Islander Australians, 2001 to 2026. Canberra: Australian Bureau of Statistics
  11. End stage renal disease notifications, by Indigenous status, age, jurisdiction and year [2009 to 2013, unpublished] (2014) Australian and New Zealand Dialysis and Transplant Registry
  12. Australian Bureau of Statistics (2011) Australian demographic statistics, June quarter 2011. Canberra: Australian Bureau of Statistics
  13. Australian Bureau of Statistics (2003) Australian demographic statistics quarterly: September quarter 2002. Canberra: Australian Bureau of Statistics
  14. Clayton P, Grace B, Chapman J, Wright J, McDonald S (2013) Transplant waiting list. In: Australia and New Zealand Dialysis and Transplant Registry, ed. The thirty sixth annual Australia and New Zealand Dialysis and Transplant Registry report 2013. Adelaide: Australia and New Zealand Dialysis and Transplant Registry: 7.1 - 7.8
  15. Polkinghorne K, Briggs N, Khanal N, Hurst K, Clayton P (2013) Haemodialysis (including home haemodialysis). In: Australia and New Zealand Dialysis and Transplant Registry, ed. The thirty sixth annual Australia and New Zealand Dialysis and Transplant Registry report 2013. Adelaide: Australia and New Zealand Dialysis and Transplant Registry: 5.1 - 5.42
  16. Prout S, Yap M (2010) Indigenous temporary mobilities and service delivery in regional service centres: a West Kimberley case study. Canberra: Centre for Aboriginal Economic Policy Research
  17. Agar JWM, Hawley CM, George CRP, Mathew TH, McDonald SP, Kerr PG (2010) Home haemodialysis in Australia — is the wheel turning full circle?. Medical Journal of Australia; 192(7): 403-406
  18. Boudville N, Dent H, McDonald S, Hurst K, Clayton P (2013) Peritoneal dialysis. In: Australia and New Zealand Dialysis and Transplant Registry, ed. The thirty sixth annual Australia and New Zealand Dialysis and Transplant Registry report 2013. Adelaide: Australia and New Zealand Dialysis and Transplant Registry: 6.1 - 6.31
  19. Grace B, Hurst K, McDonald S, Clayton P (2013) Stock and flow. In: Australia and New Zealand Dialysis and Transplant Registry, ed. The thirty sixth annual Australia and New Zealand Dialysis and Transplant Registry report 2013. Adelaide: Australia and New Zealand Dialysis and Transplant Registry: 1.1 - 1.8
  20. Australian Institute of Health and Welfare (2014) Cardiovascular disease, diabetes and chronic kidney disease: Australian facts: morbidity - hospital care. Canberra: Australian Institute of Health and Welfare
  21. Steering Committee for the Review of Government Service Provision (2014) Overcoming Indigenous disadvantage: key indicators 2014. Canberra: Productivity Commission
  22. Australian Institute of Health and Welfare (2010) Chronic kidney disease hospitalisations in Australia 2000–01 to 2007–08. Canberra: Australian Institute of Health and Welfare
  23. Australian Institute of Health and Welfare (2014) Australian hospital statistics 2012-13. Canberra: Australian Institute of Health and Welfare
  24. Australian Bureau of Statistics (2014) Causes of death, Australia, 2012: Deaths of Aboriginal and Torres Strait Islander Australians [data cube]. Retrieved 25 March 2014 from http://www.abs.gov.au/ausstats/subscriber.nsf/log?openagent&3303_12%20deaths%20of%20aboriginal%20and%20torres%20strait%20islander%20australians.xls&3303.0&Data%20Cubes&0585A7BA09CCB81DCA257CA5000C9072&0&2012&25.03.2014&Latest
  25. Lalor E, Cass A, Chew D, Craig M, Davis W, Grenfell R, Hoy W, McGlynn L, Mathew T, Parker D, Shaw J, Tonkin A, Towler B (2014) Cardiovascular disease, diabetes and chronic kidney disease: Australian facts - mortality. Canberra: Australian Institute of Health and Welfare

Endnotes

  1. Data presented in this report refer to episodes of admitted care, meaning the same patient can potentially have multiple hospitalisations within the same period. Consequently, data represent health service usage by those with CKD rather than representing the number or proportion of people in Australia with CKD admitted to hospital.
  2. Disease of the urinary system includes disorders of the bladder and urethra, as well as those specifically of the kidneys and ureters.
 

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    Last updated: 16 April 2015
     
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