Tier 1—Health conditions—1.10 Kidney disease

Why is it important?:

The kidneys can be permanently damaged by various acute illnesses (e.g., severe infections) or by progressive damage from chronic conditions such as elevated blood pressure and long-standing high blood sugar levels (untreated diabetes). If the kidneys cease functioning entirely (known as end-stage renal disease, or kidney failure), waste products and excess water build up rapidly in the body. This can cause death within a few days or weeks unless a machine is used to filter the blood several times per week (renal dialysis) or a new kidney is provided by transplant. Renal failure was estimated to contribute 5% of the burden of disease for Aboriginal and Torres Strait Islander peoples (Vos et al. 2007).

Aboriginal and Torres Strait Islander peoples have very high levels of end-stage renal disease (ESRD) due to a range of risk factors including low birthweight (see measure 1.01) (White et al. 2010a). Among non-Indigenous Australians, ESRD usually occurs in older age, but for Aboriginal and Torres Strait Islander peoples, it occurs more frequently in the middle adult years. Particular forms of kidney disease occur almost exclusively in Indigenous children in Australia and New Zealand (White et al. 2010a). Fewer Aboriginal and Torres Strait Islander patients receive kidney transplants, so most must have dialysis three times a week for the rest of their lives, impacting greatly on quality of life and social and emotional wellbeing (AIHW 2005a; McDonald et al. 2006; Devitt et al. 2008).Top of page

Findings:

In 2004–05, 2% of Aboriginal and Torres Strait Islander peoples reported that they had kidney disease (3% in remote areas and 1% non-remote areas). After adjusting for age differences in the two populations, this was 10 times the non-Indigenous rate.

During 2006–10, 3% of deaths among Aboriginal and Torres Strait Islander peoples (323) were due to kidney disease. After adjusting for the different age profiles of the two populations, this was four times the non-Indigenous rate. There has been a significant increase in kidney disease mortality rates for Aboriginal and Torres Strait Islander peoples between 2001 and 2010 and a widening of the gap with non-Indigenous Australians.

Care involving dialysis was the leading cause of hospitalisation (44%) for Aboriginal and Torres Strait Islander peoples in the period July 2008 to June 2010. Hospitalisation for dialysis was 11 times the non-Indigenous rate. There were also 4,060 hospitalisations for Indigenous Australians during this period for chronic kidney disease. This was five times the non-Indigenous rate, with the greatest difference for diabetic nephropathy (11 times). Hospitalisation rates for dialysis and chronic kidney disease were highest in the NT (1,013 per 1,000) and lowest in NSW (194 per 1,000) and Victoria (195 per 1,000).

The incidence of patients commencing ongoing renal replacement treatment (dialysis or kidney transplantation) for ESRD is higher for Aboriginal and Torres Strait Islander peoples than non-Indigenous Australians. Between 2008 and 2010, there were 644 new Aboriginal and Torres Strait Islander patients registered as commencing ESRD treatment, accounting for 9% of all new registrations. The age-adjusted incidence rate of treated ESRD was seven times as high for Aboriginal and Torres Strait Islander peoples as non-Indigenous people.Top of page

Aboriginal and Torres Strait Islander peoples commencing ESRD treatment are generally much younger than non-Indigenous Australians commencing ESRD treatment, with 62% aged less than 55 years compared with 30% of other Australians commencing ESRD treatment. ESRD incidence was higher for Aboriginal and Torres Strait Islander peoples in all adult age groups, with the greatest gap seen in the 55–64 year age group.

In the period 2008–10, incidence rates for Indigenous Australians were highest in the NT (151 per 100,000) and lowest in NSW/the ACT (29 per 100,000). ESRD incidence was higher in outer regional and remote areas than urban areas. For non-Indigenous Australians, there is little difference in ESRD incidence between jurisdictions or between urban, rural and remote areas.

The incidence of ESRD among Indigenous Australians has increased by 96% over the period 1991–2010. ESRD incidence for non-Indigenous Australians has also increased, but not as rapidly, therefore, the gap has significantly increased. The increase in the incidence of ESRD in the Aboriginal and Torres Strait Islander population may reflect both real growth in the underlying disease, an increase in availability of kidney treatment and/or improved levels of identification of Aboriginal and Torres Strait Islander peoples in the registry.

ESRD patients require either a kidney transplant or dialysis to maintain the functions normally performed by the kidneys. In December 2010, there were 1,385 Indigenous Australians registered for ESRD. Of these, 87% were reliant on dialysis and only 13% had received a kidney transplant. In comparison, 53% of non-Indigenous Australians living with ESRD were reliant on dialysis and 47% had a kidney transplant. After adjusting for differences in the age structure of the two populations, Aboriginal and Torres Strait Islander peoples with ESRD were 15 times as likely as non-Indigenous Australians with ESRD to be reliant on dialysis.Top of page

Implications:

The very high level of ESRD among Aboriginal and Torres Strait Islander peoples is associated with the high rates of diabetes, high blood pressure and related diseases, low birthweight, and possibly the high rates of bacterial infections and glomerulonephritis in childhood (AIHW 2005a). These, in turn, are associated with barriers to accessing primary care and environmental determinants. Healthier nutrition and greater physical activity play a role, as well as early diagnosis and treatment of conditions associated with renal failure.

In response to increasing demand, some jurisdictions and communities have enhanced home or community-based dialysis services. A Mobile Dialysis Bus service offers respite dialysis to remote communities in the Northern Territory and Anangu Pitjantjatjara Yankunytjatjara (APY) Lands in South Australia, on a frequent basis. This is particularly important for remote communities, where people with ESRD often need to travel long distances, or else permanently relocate, in order to receive dialysis. Indigenous Australians have relatively poorer access to kidney transplants and addressing barriers is important (Cass et al. 2003; Yeates et al. 2009). A study of Australian nephrologists has found that, in the absence of robust evidence on predictors of post-transplant outcomes, decisions on which patients to refer for kidney transplantation are not based on systematic formal approaches. Instead, decisions may be influenced by factors such as kidney shortages, perceived compliance with dialysis as a predictor of compliance with transplant regimes (despite large differences in these regimes), and, anecdotal evidence suggests, experiences with other Indigenous patients. This approach is currently leading to Indigenous patients being more commonly identified as 'high-risk' transplant candidates (Anderson et al. 2012).

A focus on improving primary prevention, detection and management is necessary to lessen the impact of ESRD on people with the condition and in terms of the cost to the health care system and to Aboriginal and Torres Strait Islander peoples. The National Partnership on Closing the Gap in Indigenous Health Outcomes (COAG 2008c) sets a number of priorities aimed at chronic disease prevention, detection and management.Top of page

Figure 39—Age-standardised registration rates for end-stage renal disease, by Indigenous status, 1991 to 2010

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Figure 40—Incidence of end-stage renal disease by Indigenous status and age group, 2008–10

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Figure 41—Age-standardised incidence of end-stage renal disease by Indigenous status and remoteness, 2008–10

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Table 10—Total patients with end-stage renal disease, by Indigenous status and treatment, 31 December 2010

	Indigenous number	Non-Indigenous number	Indigenous rate per 100,000	Non-Indigenous rate per 100,000	ratio
Dialysis	1,208	9,382	428	29	15*
Transplant	177	8,232	58	34	1.7*
Total	1,385	17,614	485	63	7.7*

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Table 11—Incidence of end-stage renal disease among Aboriginal and Torres Strait Islander peoples, by jurisdiction, 2008–10

	Male number	Male rate(a)	Male ratio	Female number	Female rate(a)	Female ratio	Persons number	Persons rate(a)	Persons ratio
New South Wales/ACT	34	26	2	48	33	5	82	29	3
Victoria	10	n.p.	n.p.	12	n.p.	n.p.	22	38	4
Queensland	87	77	6	80	56	8	167	65	7
Western Australia	59	98	8	73	115	19	132	107	12
South Australia	26	129	10	26	98	16	52	110	12
Tasmania	n.p.	n.p.	n.p.	n.p.	n.p.	n.p.	3	7	1
Northern Territory	76	132	11	110	166	n.p.	186	151	15
Australia(b)	292	70	6	349	72	11	641	71	7

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