Kidney health (renal disease)

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Kidney health (renal disease)

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 [1][2]. 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 [3][4]. CKD is inclusive of different conditions, including diabetic nephropathy, hypertensive renal disease, glomerular disease, chronic renal failure, and end-stage renal disease (ESRD) [5]. 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 [3][6].

A number of risk factors are associated with kidney disease, including diabetes, high blood pressure, infections, LBW, and obesity [4]. These conditions are particularly common among Indigenous people and contribute to high rates of CKD [5][7].

Extent of kidney disease among Indigenous people

Prevalence

The prevalence of CKD is higher among Indigenous people than among other Australians [8][5][9]. After age-adjustment, the Indigenous/non-Indigenous ratio of CKD increased from 5.3 in 2001 to 10.0 in 2004-2005 [5].

With most information on CKD limited to self-reported data, the primary focus in the literature has been on ESRD [4][9]. The overall incidence rate of ESRD for Indigenous people is consistently reported as being significantly higher than that for non-Indigenous people [2][9].

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 ([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 (1,579 per 1,000,000), WA (1,014 per 1,000,000), and SA (924 per 1,000,000).

Table 20: 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, 2006-2010

Jurisdiction	Indigenous		Non-Indigenous		Rate ratio
	Number	Rate	Number	Rate
Source: Derived from ANZDATA, 2010 [13], ABS, 2008 [10], ABS, 2001 [11], ABS, 2009 [12]
Notes: Rates per 1,000,000 population have been standardised using the ERP from 30 June 2001 Rate ratio is the Indigenous rate divided by the non-Indigenous rate 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	129	284	3,647	98	2.9
Vic	41	464	2,716	103	4.5
Qld	299	730	2,129	103	7.1
WA	222	1,014	1,012	97	10.5
SA	76	924	840	107	8.6
NT	324	1,579	54	79	20.0
Australia	1,104	702	10,914	97	7.2

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 [10][11][12][13]) (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).

Table 21: Numbers of notifications and notification rates of end-stage renal disease, by Indigenous status and age-group, and Indigenous:non-Indigenous rate ratios, Australia, 2006-2010

Age-group (years)	Indigenous		Non-Indigenous		Rate ratio
	Number	Rate	Number	Rate
Source: Derived from ANZDATA, 2010 [13], ABS, 2008 [10], ABS, 2001 [11], ABS, 2009 [12]
Notes: Rates per 1,000,000 population Rate ratio is the Indigenous rate divided by the non-Indigenous rate Rates for ‘All ages' are age-standardised
0-14	5	5	134	7	0.7
15-24	19	35	240	17	2.1
25-34	77	206	497	34	6.0
35-44	240	708	880	58	12.2
45-54	348	1,437	1,547	106	13.5
55-64	287	2,106	2,282	191	11.0
65-74	109	1,851	2,775	374	4.9
75+	19	713	2,559	384	1.9
All ages	1,104	702	10,914	97	7.2

Management of ESRD involves dialysis or kidney replacement therapy (KRT), also known as renal replacement therapy (RRT), where transplantation of the kidney is required [14]. In the three-year period 2008 to 2010, 644 Indigenous people commenced treatment for ESRD, accounting for 9% of new registrations [15]. 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 [9]. 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 [9][16][17][18]. 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 [9]. 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.

Hospitalisation

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 [19]. 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 [4]. 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 [20].

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 [21].

Mortality

During the five-year period 2006 to 2010, there were 323 Indigenous deaths from kidney disease, accounting for 3% of all Indigenous deaths [15]. 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) [4]. 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 [4]. 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.

References

1. National Kidney and Urologic Diseases Information Clearinghouse (2009) The kidneys and how they work. Retrieved 2009 from http://kidney.niddk.nih.gov/kudiseases/pubs/pdf/yourkidneys.pdf
2. Australian Institute of Health and Welfare (2009) An overview of chronic kidney disease in Australia, 2009. Canberra: Australian Institute of Health and Welfare
3. Kidney Health Australia (2010) The economic impact of end-stage kidney disease in Australia - projections to 2020. Melbourne: Kidney Health Australia
4. 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
5. 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
6. Australian Institute of Health and Welfare (2009) Health care expenditure on chronic kidney disease in Australia 2004-05. Canberra: Australian Institute of Health and Welfare
7. Steering Committee for the Review of Government Service Provision (2011) Report on government services 2011: Indigenous compendium. Canberra: Productivity Commission
8. Australian Institute of Health and Welfare (2011) Aboriginal and Torres Strait Islander health performance framework 2010: detailed analyses. Canberra: Australian Institute of Health and Welfare
9. Australia and New Zealand Dialysis and Transplant Registry (2010) The thirty third report: Australia and New Zealand Dialysis and Transplant Registry: 2010. Adelaide: Australia and New Zealand Dialysis and Transplant Registry
10. Australian Bureau of Statistics (2008) Australian Demographic Statistics: June quarter 2008. Canberra: Australian Bureau of Statistics
11. Australian Bureau of Statistics (2001) Australian demographic statistics: June quarter 2001. Canberra: Australian Bureau of Statistics
12. Australian Bureau of Statistics (2009) Experimental estimates and projections, Aboriginal and Torres Strait Islander Australians: Projected population, Aboriginal and Torres Strait Islander Australians, Australia, states and territories, 2006-2021 series [data cube]. Retrieved 8 September 2009 from http://www.abs.gov.au/ausstats/subscriber.nsf/log?openagent&32380ds002_2006.srd&3238.0&Data%20Cubes&E79A5308D989173FCA25762A001CE1C3&0&1991%20to%202021&08.09.2009&Latest
13. End stage renal disease notifications, by Indigenous status, age, jurisdiction and year [unpublished] (2011) Australian and New Zealand Dialysis and Transplant Registry
14. Australian Institute of Health and Welfare (2012) Australia's health 2012. Canberra: Australian Institute of Health and Welfare
15. Australian Health Ministers’ Advisory Council (2012) Aboriginal and Torres Strait Islander health performance framework: 2012 report. Canberra: Office for Aboriginal and Torres Strait Islander Health, Department of Health and Ageing
16. Preece C (2010) Developing a model of care to improve the health and well-being for Indigenous people receiving renal dialysis treatment. Master of Applied Science (Research) thesis, Queensland University of Technology: Brisbane
17. 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
18. 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
19. Australian Institute of Health and Welfare (2012) Australian hospital statistics 2010-11 supplementary tables. Canberra: Australian Institute of Health and Welfare
20. 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
21. Australian Institute of Health and Welfare (2009) Australian hospital statistics 2007-08. Canberra: Australian Institute of Health and Welfare

Endnotes

13. Renal (and urologic) disease includes conditions affecting the function of the body's urinary system, which involves the kidneys, ureters, bladder and urethra.

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.

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