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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 . 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, 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 . 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 .
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 .
Around 1.7% of Indigenous people reported that they had kidney disease as a long-term health condition in the 2012-2013 AATSIHS . 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 (4.0) than for females (3.5). The reported prevalence of kidney disease was less than 1% for Indigenous people aged less than 45 years, but around 6% for those aged 45 years or older.
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) for the five-year period 2008-2012 reveal that the age-standardised notification rate of ESRD for Indigenous people was 693 per 1,000,000 population, 7.3 times the rate for non-Indigenous people (Table 24) (Derived from ). Notification rates of ESRD were higher for Indigenous people than those for non-Indigenous people in all states and territories, with the highest rates recorded for Indigenous people living in the NT (1,537 per 1,000,000), WA (1,046 per 1,000,000), and SA (946 per 1,000,000).
|Source: Derived from ANZDATA, 2013 , ABS, 2010 , ABS, 2001 , ABS, 2009 |
Of people newly registered with the ANZDATA in 2008-2012, 61% 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 25) (Derived from ). Rate ratios were particularly high for people aged 35-44 years (12.1) and 45-54 years (13.7).
|Age-group (years)||Indigenous||Non-Indigenous||Rate ratio|
|Source: Derived from ANZDATA, 2013 , ABS, 2010 , ABS, 2001 , ABS, 2009 |
Detailed information from ANZDATA is available for 2011 when a total of 250 Indigenous people commenced dialysis, an increase from the numbers in 2009 and 2010, but similar to those for 2007 and 2008 . In 2011, 28 new transplant operations were performed for Indigenous recipients, compared with 770 operations performed for non-Indigenous recipients. At 31 December 2010, 49 (4%) of the 1,190 patients on the waiting list for a transplantation were Indigenous . Detailed information about the age and residence of the Indigenous patients on the waiting list is not known for 2011, but of the 977 patients aged less than 65 years on the transplant waiting list in Australia at 31 December 2009, 39 (4%) were Indigenous . The highest number of Indigenous patients on the waiting list lived in WA and NSW (36% and 33% respectively 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 2011, HD accounted for the majority of treatment (90%) , with only 10% of Indigenous dialysis patients receiving peritoneal dialysis (PD) . The majority of non-Indigenous dialysis patients also received HD, but 19% of non-Indigenous dialysis patients received PD. In 2011, there were 1,302 prevalent dialysis patients in Australia (including both PD and HD) identified as Indigenous, with a level 4.6 times higher for Indigenous people (2,269 per 1,000,000) than that for non-Indigenous people (493 per 1,000,000) .
In 2011-12, care involving dialysis was the most common reason for the hospitalisation of Indigenous people in Australia . Care involving dialysis was responsible for 162,993 hospital separations, accounting for 45% of all separations of Indigenous people. After age-adjustment, the separation rate for Indigenous people was almost 12 times that for other Australians.
More detailed information about dialysis is available for the two-year period July 2008 to June 2010 for people living in NSW, Vic, Qld, WA, SA and the NT . During this time period, Indigenous females had the highest rate of regular dialysis hospitalisations, more than 15 times that of other females; Indigenous males were hospitalised for regular dialysis, more than eight times the rate of other males.
The hospitalisation rate of Indigenous females for CKD excluding those for dialysis was more than five times that of other females; the rate for Indigenous males was more than four times that of other males .16 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 .
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 .17 After age-adjustment, the death rate for Indigenous people was 2.5 times that for non-Indigenous people.
During the five-year period 2006 to 2010, 323 Indigenous people living in NSW, Qld, WA, SA and the NT died from kidney disease (accounting for 3% of all Indigenous deaths in those jurisdictions) . After age-adjustment, the death rate for Indigenous people was four times the rate for non-Indigenous people. There was an average annual increase of 2.1% 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.
More detailed information is available for people living in NSW, Qld, WA, SA and the NT in the five-year period 2003-2007. 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 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, respectively, than those 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.