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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 filtering units of the kidneys (nephrons) which affect the kidneys ability to eliminate wastes and excess fluids [1]. 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 [2]. CKD is inclusive of different conditions, including diabetic nephropathy, hypertensive renal disease, glomerular disease, chronic renal failure, and end-stage renal disease (ESRD) [3]. 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 survive [4]. ESRD, where the kidneys are operating at less than 15% of capacity and dialysis or transplant are required [1], is expensive to treat [5] 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 [6].

A number of risk factors are associated with kidney disease, including obesity, hypertension, diabetes mellitus, tobacco use, established cardiovascular disease, age, family history, severe socio-economic disadvantage and LBW [7][8][9]. These factors are particularly common among Aboriginal and Torres Strait Islander people and contribute to high rates of CKD [4][10]

Extent of kidney disease among Aboriginal and Torres Strait Islander people
Prevalence/incidence

Around 1.8% of Aboriginal and Torres Strait Islander people reported that they had kidney disease as a long-term health condition in the 2012-2013 AATSIHS [11]. After age-adjustment, the prevalence of kidney disease as a long-term health condition was 3.7 times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people. The proportions of Aboriginal and Torres Strait Islander people reporting kidney disease were similar for males and females, but the age-adjusted Aboriginal and Torres Strait Islander: non-Indigenous rate ratio was slightly higher for males (3.9) than for females (3.6). The reported prevalence of kidney disease among Aboriginal and Torres Strait Islander people was less than 2% for all age-groups under 45 years, increasing to 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. The overall incidence rate of ESRD for Aboriginal and Torres Strait Islander people is consistently reported as being considerably higher than for non-Indigenous people [12]. Rates fluctuate from year to year but in recent years Aboriginal and Torres Strait Islander rates have stabilised.

Data from the ANZDATA27 for the five-year period 2010-2014 reveal that the age-standardised notification rate of ESRD for Aboriginal and Torres Strait Islander people was 615 per 1,000,000 population, 6.6 times the rate for non-Indigenous people (Derived from [13][14][15][16]).

Notification rates of ESRD were higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people in all states and territories, with the highest rates recorded for Aboriginal and Torres Strait Islander people living in the NT (1,696 per 1,000,000), WA (1,008 per 1,000,000), and SA (676 per 1,000,000) (Table 22) (Derived from [13][14][15][16]).

Table 22. Numbers of notifications and age-standardised notification rates for ESRD, by Indigenous status, and Aboriginal and Torres Strait Islander:non-Indigenous rate ratios, selected jurisdictions, Australia, 2010-2014

Jurisdiction

Aboriginal and Torres Strait Islander

Non-Indigenous

Rate ratio

 

Number

Rate

Number

Rate

NSW

180

313

3,727

93

3.4

Vic

58

438

3,099

101

4.3

Qld

276

490

2,060

87

5.6

WA

261

1,008

1,090

90

11.3

SA

77

676

826

87

7.8

NT

381

1,696

64

84

20.2

Australia

1,243

615

11,386

94

6.6

Notes:

  1. Rates per 1,000,000 population have been standardised using the ERP from 30 June 2001
  2. Rate ratio is the Aboriginal and Torres Strait Islander rate divided by the non-Indigenous rate
  3. Notification rates for Tas, ACT and the NT have not been shown separately because of the small numbers of notifications, but are included in the figures for Australia
  4. Rounding may result in inconsistencies in calculated ratios

Source: Derived from ANZDATA, 2015 [16], ABS, 2013 [14], ABS, 2003 [15], ABS, 2014 [13]

Of people newly registered with the ANZDATA in 2010-2014, 59% of Aboriginal and Torres Strait Islander people were aged less than 55 years, compared with 31% of non-Indigenous people. Notification rates were higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people across all age-groups (except for the 0-14 years age-group) (Table 23) (Derived from [13][14][15][16]). Rate ratios were particularly high for people aged 45-54 years (11.5).

Table 23. Numbers of notifications and notification rates of ESRD, by Indigenous status and age-group, and Aboriginal and Torres Strait Islander:non-Indigenous rate ratios, Australia, 2010-2014

Age-group (years)

Aboriginal and Torres Strait Islander

Non-Indigenous

Rate ratio

Number

Rate

Number

Rate

 

0-14

7

6

170

8

0.7

15-24

27

39

261

18

2.2

25-34

72

152

518

33

4.7

35-44

224

547

927

60

9.2

45-54

401

1,237

1,604

107

11.5

55-64

361

1,857

2,487

195

9.5

65+

151

1,255

5,419

339

3.7

All ages

1,243

615

11,386

94

6.6

Notes:

  1. Rates per 1,000,000 population
  2. Rate ratio is the Aboriginal and Torres Strait Islander rate divided by the non-Indigenous rate
  3. Rates for ‘All ages’ are age-standardised
  4. Rounding may result in inconsistencies in calculated ratios

Source: Derived from ANZDATA, 2015 [16], ABS, 2013 [14], ABS, 2003 [15], ABS, 2014 [13]

Detailed information from ANZDATA is available for 2014 when a total of 251 Aboriginal and Torres Strait Islander people commenced dialysis, representing a decrease from 2013 [12]. In 2014, there were 41 new transplant operations for Aboriginal and Torres Strait Islander recipients, compared with 873 operations performed for non-Indigenous recipients. At 31 December 2014, 32 (3%) of the 1,123 patients on the waiting list for a transplantation were Aboriginal and/or Torres Strait Islander people.

Haemodialysis (HD), conducted in urban or regional clinics and hospitals, is the most common form of dialysis treatment for Aboriginal and Torres Strait Islander people with ESRD [4][12][17][18]. In 2014, HD accounted for the majority of treatment (91%) with only 9% of Aboriginal and Torres Strait Islander dialysis patients receiving peritoneal dialysis (PD) (Derived from [12]). The majority of non-Indigenous dialysis patients also received HD, but 22% of non-Indigenous dialysis patients received PD. In 2014, there were 1,551 prevalent dialysis patients in Australia (including both PD and HD) identified as Aboriginal and Torres Strait Islander, a rate of 2,172 per 1,000,000 compared with the total population rate of 515 per 1,000,000.

Burden of disease

Kidney and urinary diseases accounted for 2.5% of the total burden of disease among Aboriginal and Torres Strait Islander people in 2011 [19].

Hospitalisation

In 2013-14 hospitalisation rates for CKD were nearly five times higher among Aboriginal and Torres Strait Islander people (52 per 1,000) than for non-Indigenous people (11 per 1,000) where CKD was the principal and/or additional diagnosis (excluding regular dialysis) [20]. For Aboriginal and Torres Strait Islander males, rates were 3.6 times higher than for non-Indigenous males for hospitalisation for CKD as the principal and/or an additional diagnosis (48 per 1,000 and 13 per 1,000 respectively). For Aboriginal and Torres Strait Islander females, rates were 6.5 times higher than for non-Indigenous females for hospitalisation for CKD as the principal and/or an additional diagnosis (56 per 1,000 and 8.6 per 1,000 respectively).

There were 207,605 hospital separations for ESRD among Aboriginal and Torres Strait Islander people in 2014-15 [21]. After age-adjustment, the hospitalisation rate for ESRD was 11.2 times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people. Aboriginal and Torres Strait Islander females had the highest rate of hospitalisation for ESRD, 17.4 times that of other females; Aboriginal and Torres Strait Islander males were hospitalised for ESRD, at 7.3 times the rate of other males.28 Contributing factors to the higher rates for Aboriginal and Torres Strait Islander females include the higher prevalence of type 2 diabetes among Aboriginal and Torres Strait Islander females and the large proportion of females carrying high levels of body fat around their abdomen; both factors place them at higher risk for CKD [22].

In 2014-15 after age-adjustment, hospitalisation rates for ESRD for Aboriginal and Torres Strait Islander people increased with remoteness [21]. In remote and very remote areas the hospitalisation rate for Aboriginal and Torres Strait Islander people was almost 70 times higher than for non-Indigenous people. For Aboriginal and Torres Strait Islander people living in remote and very remote areas, the hospitalisation rate was almost three times the rate of Aboriginal and Torres Strait Islander people living in major cities.

In 2014-15, there were 950 hospital separations per 1,000 population for Aboriginal and Torres Strait Islander people for all conditions [23]. The same-day acute separation rate for Aboriginal and Torres Strait Islander people was three times the rate for non-Indigenous people with ‘care involving dialysis’ accounting for a large proportion of these admissions.

Hospitalisation rates for regular dialysis as the principal diagnosis were 10 times higher for Aboriginal and Torres Strait Islander people (451 per 1,000) than for non-Indigenous people (44 per 1,000) [20]. For Aboriginal and Torres Strait Islander males, hospitalisation rates were 6.9 times higher than for non-Indigenous males for regular dialysis (390 per 1,000 and 57 per 1,000 respectively). For females, hospitalisation rates were almost 16 times higher than for non-Indigenous females for regular dialysis (509 per 1,000 and 33 per 1,000 respectively).

Mortality

There were 68 deaths from disease of the urinary system among Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT in 2015 [24].29 After age-adjustment, the death rate for Aboriginal and Torres Strait Islander people was 2.5 times that for non-Indigenous people.

During the period 2010-2014, after age-adjustment, the death rate for kidney disease for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and NT (26 per 100,000) was 2.7 times the rate for non-Indigenous people (10 per 100,000) [21]

More detailed information is available for people living in NSW, Qld, WA, SA and the NT for 2010-2012. During this period, CKD was the underlying cause of death of 260 Aboriginal and Torres Strait Islander people and the underlying or associated cause of death of 1,166 Aboriginal and Torres Strait Islander people [20]. After age-adjustment, the death rate for CKD as an underlying or associated cause of death for Aboriginal and Torres Strait Islander people was 3.2 times higher than the rate for non-Indigenous people. The Aboriginal and Torres Strait Islander: non-Indigenous rate ratios were higher for females (3.9) than for males (2.6).

References

  1. Kidney Foundation of Canada (2015) What is kidney disease?. Retrieved 2015 from http://www.kidney.ca/page.aspx?pid=320
  2. Chronic kidney disease (CKD) management in general practice (2015) Kidney Health Australia
  3. 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
  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. Kidney Health Australia (2010) The economic impact of end-stage kidney disease in Australia - projections to 2020. Melbourne: Kidney Health Australia
  6. Rix EF, Barclay L, Stirling J, Tong A, Wilson S (2015) The perspectives of Aboriginal patients and their health care providers on improving the quality of hemodialysis services: a qualitative study. Hemodialysis International; 19(1): 80–89
  7. Hoy WE, White AV, Tipiloura B, Singh G, Sharma SK, Bloomfield H, Swanson CE, Dowling A, McCredie DA (2015) The multideterminant model of renal disease in a remote Australian Aboriginal population in the context of early life risk factors: lower birth weight, childhood post-streptococcal glomerulonephritis, and current body mass index influence levels of albumi. Clinical Nephrology; 83(7(Supplement 1)): S75-S81
  8. Johnson D (2013) Risk factors for early chronic kidney disease. Melbourne: Kidney Health Australia
  9. Das SK, Mannan M, Faruque ASG, Ahmed T, McIntyre HD, Al Mamun A (2016) Effect of birth weight on adulthood renal function: a bias-adjusted meta-analytic approach. Nephrology; 21(7): 547-565
  10. Steering Committee for the Review of Government Service Provision (2011) Report on government services 2011: Indigenous compendium. Canberra: Productivity Commission
  11. Australian Bureau of Statistics (2014) Australian Aboriginal and Torres Strait Islander health survey: updated results, 2012–13. Canberra: Australian Bureau of Statistics
  12. Australia and New Zealand Dialysis and Transplant Registry, ed. (2016) The thirty eighth annual Australia and New Zealand Dialysis and Transplant Registry Report 2015. Adelaide: Australia and New Zealand Dialysis and Transplant Registry
  13. Australian Bureau of Statistics (2014) Estimates and projections, Aboriginal and Torres Strait Islander Australians, 2001 to 2026. Canberra: Australian Bureau of Statistics
  14. Australian Bureau of Statistics (2013) Australian demographic statistics, December quarter 2012. Retrieved 20 June 2013 from http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/3101.0Main+Features1Dec%202012?OpenDocument
  15. Australian Bureau of Statistics (2003) Australian demographic statistics quarterly: September quarter 2002. Canberra: Australian Bureau of Statistics
  16. End stage renal disease notifications, by Indigenous status, age, jurisdiction and year [2010 to 2014, unpublished] (2015) Australian and New Zealand Dialysis and Transplant Registry
  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 (2016) Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011. Canberra: Australian Institute of Health and Welfare
  20. Australian Institute of Health and Welfare (2015) Cardiovascular disease, diabetes and chronic kidney disease - Australian facts: Aboriginal and Torres Strait Islander people. Canberra: Australian Institute of Health and Welfare
  21. Steering Committee for the Review of Government Service Provision (2016) Overcoming Indigenous disadvantage: key indicators 2016 report. 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 (2016) Admitted patient care 2014-15: Australian hospital statistics. Canberra: Australian Institute of Health and Welfare
  24. Australian Bureau of Statistics (2016) Causes of Death, Australia, 2015: Deaths of Aboriginal and Torres Strait Islander Australians. Retrieved 28 September 2016 from http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0~2015~Main%20Features~Summary%20of%20findings~1

Footnotes

27. Updated information will be included when made available.

28. 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.

29. Disease of the urinary system includes disorders of the bladder and urethra, as well as those specifically of the kidneys and ureters.

In 2014, there were 1,551 prevalent dialysis patients in Australia (including both PD and HD) identified as Aboriginal and Torres Strait Islander, a rate of 2,172 per 1,000,000 compared with the total population rate of 515 per 1,000,000.[JB1] 


 [JB1]Should this go under Hospitalisation or have its own heading – Dialysis?

 

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