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Kidney disease, renal disease and renal disorder are terms that refer to a variety of different disease processes involving damage to the working units of the kidneys13 . Of particular importance to Indigenous people is chronic kidney disease (CKD), which is defined as kidney damage or reduced kidney function that lasts for three months or more . CKD is inclusive of different conditions, including diabetic nephropathy, hypertensive renal disease, glomerular disease, chronic renal failure, and end-stage renal disease (ESRD) . If left untreated, kidney function can decrease to the point where kidney replacement therapy is necessary to avoid death. CKD 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 .
A number of risk factors are associated with kidney disease, including diabetes, high blood pressure, infections, LBW, and obesity . These conditions are particularly common among Indigenous people and contribute to high rates of CKD .
The prevalence of CKD is higher among Indigenous people than among other Australians . After age-adjustment, the Indigenous/non-Indigenous ratio of CKD increased from 5.3 in 2001 to 10.0 in 2004-2005 .
With most information on CKD limited to self-reported data, the primary focus in the literature has been on ESRD . The overall incidence rate of ESRD for Indigenous people is consistently reported as being significantly higher than that for non-Indigenous people .
Data from the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) reveal that the age-standardised notification rate of 702 per 1,000,000 population for Indigenous people in 2006 to 2010 was 7.2 times the rate for non-Indigenous people (Table 20) (Derived from (). 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 (1,579 per 1,000,000), WA (1,014 per 1,000,000), and SA (924 per 1,000,000).
|Source: Derived from ANZDATA, 2010 , ABS, 2008 , ABS, 2001 , ABS, 2009 |
Of people newly registered with the ANZDATA in 2006-2010, almost two-thirds (62%) of Indigenous people were aged less than 55 years, compared with less than one-third (30%) of non-Indigenous people (Derived from ) (Table 21). Notification rates were higher for Indigenous people than for non-Indigenous people across all ages (except for the 0-14 years age-group). Rate ratios were particularly high for people aged 35-44 years (12.2) and 45-54 years (13.5).
|Age-group (years)||Indigenous||Non-Indigenous||Rate ratio|
|Source: Derived from ANZDATA, 2010 , ABS, 2008 , ABS, 2001 , ABS, 2009 |
Management of ESRD involves dialysis or kidney replacement therapy (KRT), also known as renal replacement therapy (RRT), where transplantation of the kidney is required . In the three-year period 2008 to 2010, 644 Indigenous people commenced treatment for ESRD, accounting for 9% of new registrations . After age-adjustment, the incidence rate of treatment for ESRD was 7.2 times higher for Indigenous people than for non-Indigenous people.
Detailed information from ANZDATA is available for 2009 when a total of 187 Indigenous people commenced dialysis, a decrease from 249 in 2008 and 237 in 2007 . In 2009, 24 new transplant operations were performed for Indigenous recipients compared with 748 operations performed for non-Indigenous recipients. Of the 977 patients aged less than 65 years who were on the transplant waiting list in Australia at 31 December 2009, 39 (4%) were Indigenous, with the highest number (14) residing in WA (36% of all Indigenous patients on the waiting list).
Haemodialysis (HD), conducted in urban or regional clinics and hospitals, is the most common form of dialysis treatment for Indigenous people with ESRD . In 2009, HD accounted for the majority of treatment (81%); the number of Indigenous people commencing peritoneal dialysis (PD) (35 patients) was less than in the previous two years . For the same period, there were 1,174 prevalent dialysis patients in Australia (including both PD and HD) identified as Indigenous, with a level nearly five times higher for Indigenous people (2,220 per 1,000,000) than for the total population.
In 2010-11, care involving dialysis was the most common reason for the hospitalisation of Indigenous people living in NSW, Vic, Qld, WA, SA and the NT . Care involving dialysis was responsible for 143,306 hospital separations among Indigenous people, accounting for 44% of hospital separations. The Indigenous hospitalisation rate of 503 per 1,000 was 11.4 times the rate for other Australians.
Detailed information about dialysis is available for the period 2008-09 for people living in NSW, Vic, Qld, WA, SA and the NT. During this time period, Indigenous females had the highest rates of regular dialysis hospitalisations, almost 15 times that of other females; Indigenous males were hospitalised for regular dialysis more than eight times the rate of other males . Hospitalisation rates of Indigenous females for CKD as both principal diagnosis and as an additional diagnosis were between five and seven times the rates for other females14. Contributing factors to these 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 .
In 2007-08, Indigenous people were five times more likely to be hospitalised for other principal or additional CKD diagnoses than other Australians. For the procedure of HD, the admission rate was more than 12 times that of other people .
During the five-year period 2006 to 2010, there were 323 Indigenous deaths from kidney disease, accounting for 3% of all Indigenous deaths . After age-adjustment, the death rate for Indigenous people was four times higher than the rate for non-Indigenous people. There was an increase in kidney disease-related mortality among Indigenous people between 2001 and 2010, leading to an increase in the gap between Indigenous and non-Indigenous people.
Detailed information is available for the five-year period from 2003 to 2007 for NSW, Qld, WA, SA and the NT. During this period, there were 1,443 Indigenous deaths from CKD (405 deaths had no record of Indigenous status) . After age-adjustment, the death rate for all CKD-related deaths for Indigenous people (188 per 100,000) was 3.5 times higher than the rate for non-Indigenous people. The Indigenous/non-Indigenous rate ratios were higher for females (4.3) than for males (2.9).
In 2003-2007, death rates where CKD was the underlying cause were 3.7 and 4.7 times higher for Indigenous males and females than for their non-Indigenous counterparts . These figures probably underestimate the contribution of CKD to death rates, however, as deaths involving CKD can occur in the context of other chronic conditions. For example, deaths where kidney failure was reported in 2003-2007 as an associated cause of death (e.g. with diabetes) occurred at three times the rate for Indigenous people than for non-Indigenous people.
14. 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.