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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 working units of the kidneys and associated structures [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, 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 [6]. 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 [3][7].

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][8].

Extent of kidney disease among Indigenous people
Prevalence

Around 1.7% of Indigenous people reported that they had kidney disease as a long-term health condition in the 2012-2013 AATSIHS [9][10]. 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 [4][11]. The overall incidence rate of ESRD for Indigenous people is consistently reported as being significantly higher than that for non-Indigenous people [4][12].

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 [13][14][15][16][17]). 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).

Table 24: 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, 2008-2012
JurisdictionIndigenousNon-IndigenousRate ratio
NumberRateNumberRate
Source: Derived from ANZDATA, 2013 [16], ABS, 2010 [17], ABS, 2001 [14], ABS, 2009 [15]
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 159 349 3,709 96 3.7
Vic 48 463 2,845 96 4.8
Qld 284 606 2,109 96 4.8
WA 239 1,046 1,054 93 11.3
SA 80 946 877 94 10.1
NT 338 1,537 70 96 15.9
Australia 1,163 693 11,179 95 7.3

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 [13][14][15][16]). Rate ratios were particularly high for people aged 35-44 years (12.1) and 45-54 years (13.7).

Table 25: Numbers of notifications and notification rates of end-stage renal disease, by Indigenous status and age-group, and Indigenous:non-Indigenous rate ratios, Australia, 2008-2012
Age-group (years)IndigenousNon-IndigenousRate ratio
NumberRateNumberRate
Source: Derived from ANZDATA, 2013 [16], ABS, 2010 [17], ABS, 2001 [14], ABS, 2009 [15]
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 5 5 159 8 0.6
15-24 21 36 259 17 2.1
25-34 67 170 515 33 5.2
35-44 241 698 896 58 12.1
45-54 373 1,436 1,568 105 13.7
55-64 327 2,147 2,401 192 11.2
65-74 107 1,621 2,794 348 4.7
75+ 20 785 2,587 374 2.1
All ages 1,163 693 11,179 95 7.3

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 [12]. 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 [18]. 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 [19]. 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 [20][21][22][23]. In 2011, HD accounted for the majority of treatment (90%) [12][20], with only 10% of Indigenous dialysis patients receiving peritoneal dialysis (PD) [12][24]. 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) [12].

Hospitalisation

In 2011-12, care involving dialysis was the most common reason for the hospitalisation of Indigenous people in Australia [25]. 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 [26]. 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 [26].1 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 [27].

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 [28].2 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) [26][29][26]. 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) [4]. 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 [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. 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. 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
  8. Steering Committee for the Review of Government Service Provision (2011) Report on government services 2011: Indigenous compendium. Canberra: Productivity Commission
  9. Australian Bureau of Statistics (2013) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13. Canberra: Australian Bureau of Statistics
  10. Australian Bureau of Statistics (2013) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13: Table 1 [data cube]. Retrieved 27 November 2013 from http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&table%201%20selected%20health%20characteristics,%202001%20to%202012-13-australia.xls&4727.0.55.001&Data%20Cubes&26F4FE668ABADCF4CA257C2F00145C83&0&2012-13&27.11.2013&Latest
  11. McDonald S, Clayton P, Hurst K, eds. (2012) The thirty fifth annual Australia and New Zealand Dialysis and Transplant Registry Report 2012. Adelaide: Australia and New Zealand Dialysis and Transplant Registry
  12. McDonald S, Jose M, Hurst K (2012) End-stage kidney disease among Indigenous peoples of Australia and New Zealand. In: McDonald S, Clayton P, Hurst K, eds. The thirty fifth annual Australia and New Zealand Dialysis and Transplant Registry report 2012. Adelaide: Australia and New Zealand Dialysis and Transplant Registry: 12.1-12.19
  13. Australian Bureau of Statistics (2008) Australian Demographic Statistics: June quarter 2008. Canberra: Australian Bureau of Statistics
  14. Australian Bureau of Statistics (2001) Australian demographic statistics: June quarter 2001. Canberra: Australian Bureau of Statistics
  15. 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
  16. End stage renal disease notifications, by Indigenous status, age, jurisdiction and year [2008 to 2012, unpublished] (2013) Australian and New Zealand Dialysis and Transplant Registry
  17. Australian Bureau of Statistics (2010) Australian demographic statistics, December quarter 2010. Canberra: Australian Bureau of Statistics
  18. McDonald S, Clayton P, Grace B, Chapman J, Wright J (2012) Transplant waiting list. In: McDonald S, Clayton P, Hurst K, eds. The thirty fifth annual Australia and New Zealand Dialysis and Transplant Registry report 2012. Adelaide: Australia and New Zealand Dialysis and Transplant Registry: 7.1-7.3
  19. 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
  20. Polkinghorne K, Gulyani A, McDonald S, Hurst K (2012) Haemodialysis (including home haemodialysis). In: McDonald S, Clayton P, Hurst K, eds. The thirty fifth annual Australia and New Zealand Dialysis and Transplant Registry Report 2012. Adelaide: Australia and New Zealand Dialysis and Transplant Registry: 5.1-5.41
  21. 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
  22. 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
  23. 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
  24. Brown F, Gulyani A, McDonald S, Hurst K (2012) Peritoneal dialysis. In: McDonald S, Clayton P, Hurst K, eds. The thirty fifth annual Australia and New Zealand Dialysis and Transplant Registry report 2012. Adelaide: Australia and New Zealand Dialysis and Transplant Registry: 6.1-6.32
  25. Australian Institute of Health and Welfare (2013) Australian hospital statistics 2011–12: national tables for principal diagnoses (part 1). Retrieved 19 April 2013 from http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129544524
  26. Australian Institute of Health and Welfare (2013) Aboriginal and Torres Strait Islander health performance framework 2012: detailed analyses. Canberra: Australian Institute of Health and Welfare
  27. 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
  28. 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
  29. 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

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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