Burden of disease
The contribution of CKD to the total disease burden (fatal and non-fatal) in Australia has increased since 2003. In 2015, CKD was responsible for 1.2% of the total burden compared with 0.8% in 2003. The burden of CKD increased rapidly with age, with CKD being the seventh leading cause of burden among those aged 85 and over.
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 2015, 2.1% of total disease burden could have been prevented if people had not had impaired kidney function (AIHW 2019b).
See Burden of disease.
Deaths
According to the National Mortality Database, CKD contributed to around 16,800 (11%, or 1 in 9) deaths in 2018, with 79% of these recording CKD as an associated cause of death (AIHW 2019d). CKD is more often recorded as an associated cause 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 (37%), such as coronary heart disease and heart failure and cardiomyopathy
- cancers (19%) such as prostate, lung, blood and bladder cancer
- diseases of the respiratory system (8.8%) such as COPD and pneumonia
- endocrine, nutritional and metabolic diseases (8.8%), in particular type 2 diabetes
- dementia and Alzheimer’s disease (7.6%).
CKD is often under-reported as a cause of death, as shown by linked data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) registry and National Death Index, in which over half (53%) of the patients with ESKD who received KRT and died during the period 1997–2013 did not have ESKD recorded on their death certificate (AIHW 2016b).
See Causes of death.
Hospitalisations
According to the National Hospital Morbidity Database, in 2017–18, CKD was recorded as the principal or additional diagnosis in around 1.9 million hospitalisations—17% of all hospitalisations in Australia (AIHW 2019c). Of these, 80% (1.5 million) were for regular dialysis treatment, making dialysis the most common reason for hospitalisation (AIHW 2019a). Age-standardised rates for dialysis have increased by 19% over the last decade, from 4,500 per 100,000 population in 2007–08 to 5,400 per 100,000 population in 2017–18.
There were 370,000 hospitalisations with a diagnosis of CKD (excluding regular dialysis as a principal diagnosis) in 2017–18. Most of these (84%) had CKD as an additional (rather than principal) diagnosis.
The number of hospitalisations for CKD as the principal diagnosis (excluding regular dialysis) doubled between 2000–01 and 2017–18, from 24,100 to 51,300 hospitalisations. The age-standardised hospitalisation rate for CKD increased by 54% between 2000–01 and 2017–18 (126 and 194 per 100,000 population, respectively).
See Hospital care.
Kidney replacement therapy
In 2018, around 25,400 people received KRT. KRT rates are higher in males than females at all ages as ESKD is more prevalent in the male population. KRT rates increase with age until the age of 80 and then fall from age 80. Of all people receiving KRT, 53% had dialysis while 47% had a kidney transplant. The number of people receiving KRT has more than doubled in the last 2 decades, from around 10,500 to 25,400 and the KRT rate in 2018 (92 per 100,000) was 1.6 times as high as the rate in 1998 (57 per 100,000) (Figure 3).