While chronic kidney disease is often detected too late to be reversible, it can be prevented by a healthy lifestyle, or treated if detected early.
Between July 2017 and June 2019, care involving dialysis was the leading cause of hospitalisation among Indigenous Australians, accounting for 44% (474,745) of all hospitalisations. Excluding dialysis, there were 6,710 hospitalisations for Indigenous Australians due to chronic kidney disease.
Patients with kidney failure, also known as end-stage kidney disease, require either a kidney transplant or dialysis to maintain the functions normally performed by the kidneys. These treatments are collectively known as ‘kidney replacement therapy’.
In the three-year period 2019–2021, 1,063 Indigenous Australians began kidney replacement therapy for kidney failure. This corresponds to an incidence rate of 41 new cases of kidney failure with replacement therapy for every 100,000 Indigenous Australians.
In 2019–2021, among Indigenous Australians who began receiving kidney replacement therapy, the most common type of primary kidney disease was diabetic kidney disease (also known as diabetic nephropathy) – experienced by 71% (753) of the new 1,063 Indigenous kidney replacement therapy patients. This was followed by glomerulonephritis (77 or 7.2%) and hypertension (61 or 5.7%).
The incidence of kidney failure with replacement therapy was 6 times as high for Indigenous Australians as for non-Indigenous Australians (63 compared with 10 per 100,000 population, based on age-standardised rates). Between 2012 and 2021, the age-standardised incidence rate for kidney failure with replacement therapy did not change significantly for Indigenous Australians. For non-Indigenous Australians, there was a 7.8% increase in age-standardised incidence rate for kidney failure with replacement therapy, which was mainly driven by the increases among non-Indigenous males (10% increase over the period) (Figure 4.20).
Figure 4.20: Incidence of kidney failure with replacement therapy among Indigenous Australians by remoteness area (crude rates, 2019–2021), and by Indigenous status over time (age-standardised rates, 2012 to 2021)
As at 31 December 2021, a total 2,569 Indigenous Australians with kidney failure were receiving kidney replacement therapy, a prevalence rate of 289 per 100,000 population. Most Indigenous patients with kidney failure (85% or 2,170 patients) were receiving dialysis, while 15% (or 398 patients) had received a kidney transplant. In comparison, about half (49%; 12,063 of 24,774 patients) of non-Indigenous patients received a kidney transplant.
In the 6-year period 2016–2021, 1,381 Indigenous Australians were reliant on dialysis to manage their kidney failure at the time of their death, based on underlying cause of death. The primary cause of death in over one-third (466 deaths or 34%) of these cases was cardiovascular diseases, a further one-fifth (307 deaths or 22%) was due to withdrawal from dialysis and 12% (161 deaths) was due to infections. Among Indigenous Australians who had received a transplant to manage their kidney failure, there were 49 deaths in 2016–2021 - the leading cause of these deaths was cardiovascular disease (13 deaths or 27%), followed by cancer (7 deaths or 14%), infections, and withdrawal (both 6 deaths or 12%).
Kidney diseases were the 10th leading cause of death of Indigenous Australians (1.8% of deaths of Indigenous Australians). Indigenous females accounted for 58% of deaths due to kidney disease among Indigenous Australians.
Over the decade between 2010 and 2019, the age-standardised death rate from kidney disease among Indigenous Australians decreased by 36%. However, there was no significant reduction in the gap between Indigenous and non-Indigenous Australians over this period (data from NSW, Qld, WA, SA and NT combined) (Figure 4.21).
Over the decade from 2009–10 to 2018–19, the age-standardised hospitalisation rate for a principal diagnosis of chronic kidney disease increased by 6% for Indigenous Australians. This trend was driven by the increases for Indigenous females (22%) as the rate among Indigenous males declined (16%) (Figure 4.21).
Kidney disease is more likely to be recorded as an additional diagnosis on hospitalisation administrative record or recorded on death certificates as an associated cause compared with other diseases. The above estimations of the impact of kidney disease were based on the principal diagnosis of hospitalisation or underlying cause of death; therefore, will likely underestimate the true extent of chronic kidney disease among Indigenous Australians.
Figure 4.21: Rates of hospitalisations (2009–10 to 2018–19) and deaths (2010–2019) due to kidney disease, by Indigenous status and sex (age-standardised)
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