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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 avoid death [4]. ESRD 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 socioeconomic disadvantage and LBW [7][8]. These factors are particularly common among Aboriginal and Torres Strait Islander people and contribute to high rates of CKD [4][9].

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

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 [10]. 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 [4][11]. 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 [11].

Data from the ANZDATA 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 (Table 23) (Derived from [12][13][14][15]).

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 23. Numbers of notifications and age-standardised notification rates for end-stage renal disease, by Aboriginal and Torres Strait Islander 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

1243

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 and the ACT 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 [15], ABS, 2013 [13], ABS, 2003 [14], ABS, 2014 [12]

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 24) (Derived from [12][13][14][15]). Rate ratios were particularly high for people aged 45-54 years (11.5).

Table 24. Numbers of notifications and notification rates of end-stage renal disease, by Aboriginal and Torres Strait Islander 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[15], ABS, 2013 [13], ABS, 2003 [14], ABS, 2014 [12]

Detailed information from ANZDATA is available for 2013 when a total of 264 Aboriginal and Torres Strait Islander people commenced dialysis, representing an increase from 2012 [11]. In 2013, there were 31 new transplant operations for Aboriginal and Torres Strait Islander recipients, compared with 851 operations performed for non-Indigenous recipients. At 31 December 2013, 34 (3%) of the 1,056 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][11][16][17]. In 2013, HD accounted for the majority of treatment (90%) with only 10% of Aboriginal and Torres Strait Islander dialysis patients receiving peritoneal dialysis (PD) [11]. The majority of non-Indigenous dialysis patients also received HD, but 21% of non-Indigenous dialysis patients received PD. In 2013, there were 1,478 prevalent dialysis patients in Australia (including both PD and HD) identified as Aboriginal and Torres Strait Islander, with a level 4.2 times higher for Aboriginal and Torres Strait Islander people (2,116 per 1,000,000) than for non-Indigenous people (509 per 1,000,000).

Hospitalisation

In 2013-14 hospitalisation rates for CKD were nearly five times higher among Aboriginal and Torres Strait Islander people (5,192 per 100,000) than for non-Indigenous people (1,067 per 100,000) where CKD was the principal and/or additional diagnosis (excluding regular dialysis) [18]. 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 (4,770 and 1,325 per 100,000 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 (5,568 and 862 per 100,000 respectively).

There were 172,151 hospital separations for ESRD among Aboriginal and Torres Strait Islander people in 2012-13 [19]. After age-adjustment, the hospitalisation rate for ESRD was 9.9 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, 15.1 times that of other females; Aboriginal and Torres Strait Islander males were hospitalised for ESRD, at 6.7 times the rate of other males.1 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 women and the large proportion of women carrying high levels of body fat around their abdomen; both factors place them at higher risk for CKD [20].

In 2012-13 after age-adjustment, hospitalisation rates for ESRD for Aboriginal and Torres Strait Islander people increased with remoteness [19]. In remote and very remote areas the hospitalisation rate for Aboriginal and Torres Strait Islander people was over 50 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 over twice the rate of Aboriginal and Torres Strait Islander people living in major cities.

In 2013-14, there were 896 hospital separations per 1,000 population for Aboriginal and Torres Strait Islander people for all conditions [21]. The same-day acute separation rate for Aboriginal and Torres Strait Islander people was almost 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 (45,084 per 100,000) than for non-Indigenous people (4,389 per 100,000) [18]. For Aboriginal and Torres Strait Islander males, hospitalisation rates were 6.9 times higher than for non-Indigenous males for regular dialysis (39,049 and 5,682 per 100,000 respectively). For females, hospitalisation rates were almost 16 times higher than for non-Indigenous females for regular dialysis (50,854 and 3,259 per 100,000 respectively).

Mortality

There were 66 deaths from disease of the urinary system among Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT in 2013, accounting for 2.5% of all Aboriginal and Torres Strait Islander deaths in those jurisdictions [22].2 After age-adjustment, the death rate for Aboriginal and Torres Strait Islander people was 3.1 times that for non-Indigenous people.

During the period 2008-2012, after age-adjustment, the death rate for kidney disease for Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and NT (30 per 100,000) was 2.6 times the rate for non-Indigenous people (11 per 100,000) [23].

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 [18]. 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. Steering Committee for the Review of Government Service Provision (2011) Report on government services 2011: Indigenous compendium. Canberra: Productivity Commission
  10. Australian Bureau of Statistics (2014) Australian Aboriginal and Torres Strait Islander health survey: updated results, 2012–13. Canberra: Australian Bureau of Statistics
  11. Australia and New Zealand Dialysis and Transplant Registry, ed. (2015) The thirty seventh annual Australia and New Zealand Dialysis and Transplant Registry Report 2014. Adelaide: Australia and New Zealand Dialysis and Transplant Registry
  12. Australian Bureau of Statistics (2014) Estimates and projections, Aboriginal and Torres Strait Islander Australians, 2001 to 2026. Canberra: Australian Bureau of Statistics
  13. 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
  14. Australian Bureau of Statistics (2003) Australian demographic statistics quarterly: September quarter 2002. Canberra: Australian Bureau of Statistics
  15. 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
  16. 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
  17. 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
  18. 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
  19. Steering Committee for the Review of Government Service Provision (2014) Overcoming Indigenous disadvantage: key indicators 2014. Canberra: Productivity Commission
  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 (2015) Admitted patient care 2013–14: Australian hospital statistics. Canberra: Australian Institute of Health and Welfare
  22. Australian Bureau of Statistics (2015) Causes of death, Australia, 2013. Canberra: Australian Bureau of Statistics
  23. Skov S, Miller P, Hately W, Davis J, Bastian I, Tait P, Coppola A (1995) Urine screening for gonorrhoea and chlamydia in central Australia. Central Australian Rural Practitioners Association Newsletter; 22(November): 61-65

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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