Chronic kidney disease (CKD) refers to all conditions of the kidney affecting the filtration and removal of waste from the blood for more than 3 months. CKD is identified by reduced filtration by the kidney and/or by the leakage of protein or albumin from the blood into the urine. CKD frequently occurs as a comorbidity of cardiovascular disease and diabetes (White 2020).

CKD is mostly diagnosed at more advanced stages when symptoms become more apparent. Kidney failure (also known as end stage kidney disease) occurs when the kidneys can no longer function adequately, at which point people require kidney replacement therapy (KRT) – a kidney transplant or dialysis – to survive.

CKD is largely preventable because many of its risk factors – high blood pressure, tobacco smoking, and overweight and obesity – are modifiable. Other chronic diseases, such as cardiovascular disease and diabetes, are also risk factors for CKD (KHA 2020).

Early detection of CKD by simple blood or urine tests enables treatment to prevent or slow its progression.

How common is chronic kidney disease?

An estimated 10% of people (1.7 million Australians) aged 18 and over had biomedical signs of CKD in 2011–12, according to the Australian Bureau of Statistics latest National Health Measures Survey (NHMS) (ABS 2013).

The total number of people affected by CKD (the 'prevalence') increases rapidly with age, affecting around 42% of people aged 75 and over (AIHW 2018).

Only 6.1% of NHMS respondents who showed biomedical signs of CKD self-reported having the disease, indicating that CKD is a largely underdiagnosed condition (ABS 2013). This may be because up to 90% of kidney function can be lost before a person begins to feel unwell (KHA 2017).

Change over time

Two national surveys have been conducted in Australia that provide data on biomarkers of CKD – the 1999–2000 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) and the 2011–12 NHMS.

Between 1999–2000 and 2011–12, the age-standardised CKD prevalence rate remained stable, but the number of Australians with moderate to severe loss of kidney function nearly doubled, from 322,000 in 1999–2000 to 604,000 in 2011–12. This increase was mostly driven by growth in the population of older people (as people live longer) and survival of people with kidney failure receiving KRT (AIHW 2018).

Kidney Failure

Not everyone with kidney failure chooses to receive KRT, opting instead for end-of-life care. Therefore, estimates of the prevalence of kidney failure need to count kidney failure both with and without KRT. The most recent data available to examine this are linked data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) registry and the National Death Index, covering the period from 1997 to 2013 (AIHW 2016).

There were around 5,100 new cases of kidney failure in Australia in 2013, which equates to around 14 new cases per day. Of these, around 50% were receiving KRT.

Whether people with kidney failure are treated with KRT varies with age. Prior to age 75, most new cases of kidney failure are treated with KRT, however this trend reverses after age 75, where there was an 11-fold increase in kidney failure without KRT compared with ages 65–74 (from 13 to 145 per 100,000 population) (Figure 1).

In 2013, 92% of people newly diagnosed with kidney failure aged under 55 received KRT, compared with 19% of people newly diagnosed with kidney failure aged 75 and over.

 

This chart shows the incidence rate of end-stage kidney disease (ESKD) in 2013 by sex, age group and kidney replacement therapy (KRT) treatment status, from the AIHW analysis of the linked ANZDATA, AIHW National Mortality Database and National Death Index.

The treatment rate for new patients with ESKD increased slightly with age from 4.8 per 100,000 population among persons aged under 55, to 35 per 100,000 population among persons aged 75 and over. In contrast, the rate of new patients with ESKD who did not get any KRT treatment increased sharply from 0.4 per 100,000 population among those aged under 55 to 145 per 100,000 population among those aged 75 and over. These age patterns are similar for men and women, with higher ESKD incidence rates observed for males.

Between 1997 and 2013, the number of new cases of kidney failure with KRT and without KRT increased by 71% and 35% respectively. After accounting for changes in the age structure of the population between 2001 and 2013 (age-standardising), the incidence rate for both treatment groups has remained relatively stable (AIHW 2016). 

Impact

Burden of disease

Burden of disease refers to the quantified impact of living with and dying prematurely from a disease or injury.

The contribution of CKD to the total disease burden (fatal and non-fatal) in Australia has increased since 2003. In 2018, CKD was responsible for 1.0% of the total burden, compared with 0.8% in 2003. The burden of CKD increased rapidly with age, being the 18th leading cause of fatal burden across all age groups and the eighth and ninth leading cause of fatal burden amongst females and males aged 85 and over, respectively (AIHW 2021b).

Impaired kidney function contributes to the burden of CKD as well as several other diseases, including gout, peripheral vascular disease, dementia, coronary heart disease and stroke. In 2018, 1.9% of total disease burden could have been prevented if people had not had impaired kidney function (AIHW 2021a).

Among Aboriginal and Torres Strait Islander people, CKD was the 10th leading cause of total burden (2.5% of all burden in 2018). This was higher for females than males – CKD was the eighth leading cause of total burden among females, accounting for 3.1% of the total burden. In males, CKD accounted for 2.3% of the total burden and was the 13th leading cause of total burden (AIHW 2022b).

See Burden of disease.

Deaths

CKD contributed to around 17,700 deaths in 2020 (11% of all deaths in Australia). Twenty-four per cent of these deaths had CKD recorded as the underlying cause of death, while 76% of these recorded CKD as an associated cause of death. The number of CKD-related deaths has increased by 75% since 2000 (10,200 deaths). The age-standardised death rate has remained stable over this time (Figure 2).

CKD is more often recorded as an associated cause of death, as the disease itself may not lead directly to death. When CKD was an associated cause of death, the most common underlying causes of death were:

  • diseases of the circulatory system (33%), such as coronary heart disease, and heart failure and cardiomyopathy
  • cancers (21%), such as prostate, lung, blood, and bladder cancer
  • endocrine, nutritional and metabolic diseases (10%), in particular type 2 diabetes
  • diseases of the respiratory system (8%), such as chronic obstructive pulmonary disease and pneumonia.

CKD is often under-reported as a cause of death, as shown by linked data from the ANZDATA registry and National Death Index, in which 53% of the people with kidney failure who received KRT and who died during the period 1997–2013 did not have kidney failure recorded on their death certificate (AIHW 2016).

See Causes of death.

 

This graph shows the age-standardised rate of deaths where CKD was recorded as either an underlying or associated cause of death, from 2000 to 2020. The rate has remained relatively stable for males and females over that time, though rates are higher in males than in females. For persons, the rate of CKD deaths per 100,000 population was 55 in 2000, and 52 in 2020. The highest rate was in 2008, with 61 deaths per 100,000 population.

Treatment and management

Hospitalisations

In 2019–20, CKD was recorded as the principal or additional diagnosis of around 1.9 million hospitalisations – 17% of all hospitalisations in Australia.

Dialysis was the most common reason for hospitalisation in Australia in 2019–20, accounting for 14% of all hospitalisations, and 81% of CKD hospitalisations (1.5 million). Age-standardised rates for dialysis have increased by 5.5% over the last decade.

There were 374,000 hospitalisations with a diagnosis of CKD (excluding dialysis as a principal diagnosis) in 2019–20. Eighty-six per cent of these had CKD as an additional (rather than principal) diagnosis.

The number of hospitalisations for CKD as the principal diagnosis (excluding dialysis) more than doubled between 2000–01 and 2019–20, from 24,000 to 54,100 hospitalisations. The age-standardised hospitalisation rate for CKD increased by 56% between 2000–01 and 2019–20.

See Hospitals.

Kidney replacement therapy

In 2020, around 27,700 people received KRT.

KRT rates were higher in males than females across all ages. Of all people receiving KRT, 53% had dialysis while 47% had a kidney transplant. The number of people receiving KRT has more than doubled since 2000, from around 11,700 to 27,700. The age-standardised KRT rate in 2020 was 1.6 times as high as the rate in 2000 (Figure 3).

 

This graph shows the increasing trend of persons with end-stage kidney disease (ESKD) who are receiving kidney replacement therapy (KRT), by sex, from 2000 to 2020. The age-standardised rates have increased by 36%, from 62 per 100,000 in 2000 to 95 per 100,000 in 2020, with rates consistently higher in males than females. In 2020, the rate of persons with ESKD receiving KRT was approximately 1.7 times higher among males (120 per 100,000 population) than females (73 per 100,00 population).

Variation between population groups

The impact of CKD varies between population groups. To account for differences in the age structures of these groups, the data presented below is based on age-standardised rates.

CKD was 2.1 times as prevalent among Indigenous Australians compared with non-Indigenous Australians, based on data from the 2011–12 NHMS and the 2012–13 National Aboriginal and Torres Strait Islander Health Measures Survey. The overall burden of disease was 7.8 times as high in Indigenous Australians compared to non-Indigenous Australians (AIHW 2021b, 2022a).

Generally, the impact of CKD increases with rising socioeconomic disadvantage and remoteness. Rates of CKD hospitalisation in 2019–20 were 2.2 times as high in the lowest socioeconomic areas compared with the highest, and 3.0 times as high in Remote and very remote regions compared with Major cities (Figure 4).

 

This table shows the relative impact of CKD in selected population groups, in terms of rates of: 1) prevalence, 2) hospitalisation, 3) death, 4) incidence of end-stage kidney disease (ESKD), 5) ESKD patients receiving kidney replacement therapy, and 6) burden of disease. For each impact, rates are shown as a ratio comparing Indigenous and non-Indigenous Australians, people living in Remote and Very remote areas compared to Major cities, and people living in the lowest compared to the highest socioeconomic areas. Across all measures, the impact of CKD was higher for Indigenous Australians compared to non-Indigenous Australians, higher for people living in Remote and Very remote areas compared to Major cities, and higher for people living in the lowest socioeconomic area compared to the highest.

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COVID-19 and chronic kidney disease

Measures to manage COVID-19 (for example, stay-at-home orders and selected service closures or suspensions) resulted in changes to health service use for people with CKD.  

Organ donation numbers and transplants have declined since 2019, as a result of the pandemic (OTA, 2021). Pauses in kidney transplant surgery particularly affect CKD, as more than half of transplanted organs are kidneys. In 2020, there was an 18% decrease in the number of kidney transplants from deceased donors compared to 2019, and 2021 saw a decrease of 7% compared with 2020. There was a 24% drop in living kidney donors in 2020; in 2021 the number of living kidney donors increased by 12% compared with 2020 (OTA, 2020, 2021).

In 2020–21, there were over 4,700 hospitalisations in Australia that involved a COVID-19 diagnosis. Almost 400 (8.4%) of these hospitalisations were for people who had a diagnosis of CKD recorded on the admission. Of these, 64 (16%) required a stay in the intensive care unit, 48 (12%) required continuous ventilatory support (AIHW 2022a).

People hospitalised with COVID-19 and CKD in 2020-21 died in hospital at a higher rate than people with any other comorbid condition (29%, 113 deaths), with the exception of chronic obstructive pulmonary disease (31%, 65 deaths). This includes type 2 diabetes (19%, 188 deaths) and cardiovascular disease (20%, 189 deaths), which are often comorbid with CKD. The death rate for people with CKD and COVID-19 was also higher than for people with multiple comorbid conditions who were hospitalised with COVID-19 (26%) and people with no comorbid conditions (4.7%) (AIHW 2022a).

Where do I go for more information?

More information on CKD is available at:

Visit Chronic kidney disease for more on this topic.

References

ABS (Australian Bureau of Statistics) (2013) Australian Health Survey: Biomedical results for chronic diseases, ABS, Australian Government, accessed 22 February 2022.

AIHW (Australian Institute of Health and Welfare) (2014) Cardiovascular disease, diabetes and chronic kidney disease—Australian facts: prevalence and incidence, AIHW, Australian Government, accessed 26 March 2022.

AIHW (2015) Cardiovascular disease, diabetes and chronic kidney disease—Australian facts: Aboriginal and Torres Strait Islander people, AIHW, Australian Government, accessed 26 March 2022.

AIHW (2016) Incidence of end-stage kidney disease in Australia 1997–2013, AIHW, Australian Government, accessed 26 March 2022.

AIHW (2018) Chronic kidney disease prevalence among Australian adults over time, AIHW, Australian Government, accessed 26 March 2022.

AIHW (2021a) Australian Burden of Disease Study 2018: Interactive data on risk factor burden, AIHW, Australian Government, accessed 16 March 2022.

AIHW (2021b) Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2018, AIHW, Australian Government, accessed 3 February 2022.

AIHW (2021c) National Hospital Morbidity Database, AIHW, Australian Government, accessed 12 April 2022.

AIHW (2022a) Admitted Patient Care 2020-21 Separations with a COVID-19 diagnosis, AIHW, Australian Government, accessed 6 June 2022.

AIHW (2022b) Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2018, AIHW, Australian Government, accessed 16 March 2022.

AIHW (2022c) National Mortality Database, aihw.gov.au, accessed 12 April 2022.

ANZDATA (Australia and New Zealand Dialysis and Transplant Registry) (2020) ANZDATA Registry, AIHW analysis of ANZDATA, accessed 1 February 2022.

KHA (Kidney Health Australia) (2017) All about Chronic Kidney Disease (CKD), KHA, accessed 21 February 2021.

KHA (2020) Risk factors of kidney disease, KHA, accessed 1 September 2021.

OTA (Organ and Tissue Authority) (2020) 2020 Australian donation and transplantation activity report, OTA, Australian Government, accessed 16 March 2022.

OTA (2021) 2021 Australian donation and transplantation activity report, OTA, Australian Government, accessed 16 March 2022.

White SL (2020) Chronic kidney disease, diabetes and cardiovascular disease: Evidence report 2021, Kidney Health Australia, Melbourne, accessed 26 March 2022.