Treatment of kidney failure

On this page:
Kidney failure
Comprehensive conservative care and kidney supportive care
Incidence of kidney replacement therapy
Treatment on Country
Prevalence of kidney replacement therapy

In 2020, 27,700 people with kidney failure in Australia were receiving KRT.

  • 13,100 (47%) had functioning kidney transplants.
  • 14,600 (53%) were on dialysis.

Of the people receiving KRT, 61% were males (17,000) and 71% (19,700) were aged under 70.

This web page presents statistics on the number of people with kidney failure receiving kidney replacement therapy (KRT), using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry.

Not all people with kidney failure choose to undergo KRT. Instead, some opt to receive comprehensive conservative care, with a focus on quality of life and symptom control.

Whether a person chooses to receive KRT is a personal decision, and may depend on a variety of factors, such as the person’s age and expected quality of life receiving KRT versus comprehensive conservative care. Person-centred care emphasises that the choice of what type of treatment to receive be made collaboratively by the person with kidney failure, their families and their care team.

Kidney failure

Kidney failure is the most severe form of chronic kidney disease (CKD). It occurs when the kidneys can no longer function adequately on their own.

People with kidney failure require KRT to survive. KRT involves either dialysis or a kidney transplant.

In 2020, 73% of new kidney failure cases were attributable to 4 causes: diabetes (38%), glomerulonephritis (a type of kidney inflammation) (18%), hypertension (12%) and polycystic disease (the presence of multiple cysts in the kidney) (5.4%) (ANZDATA 2021).

Comprehensive conservative care and kidney supportive care

Not all people with kidney failure undertake KRT – comprehensive conservative care and management of kidney failure is a treatment choice that focusses on patient care, quality of life and symptom control rather than on efforts to prolong life.

Kidney supportive care aims to improve the quality of life of people living with CKD, regardless of whether they are undergoing therapies intended to prolong life (Davison et al. 2015).

This care includes preventing and relieving pain and takes into account other physical, psychological, social or spiritual needs, helping people to live as actively as possible until death (WHO 2022). It emphasises shared decision-making between the person with CKD, their families and their health care team.

For a person near the end of their life, comprehensive conservative care with supportive care may be a more suitable form of care. Decisions on whether to start or withdraw from KRT are made by the person living with CKD and their family. These decisions are informed by the person’s health-care team (including their general practitioner and nephrologist); they consider people’s prognoses, as well as assessments of the person’s anticipated quality of life (with or without dialysis) and treatment burdens (AIHW 2016).

For each person who started KRT in 2013, there was one person with kidney failure who chose not to receive KRT (AIHW 2016).

For more information on quality of life for people with CKD, see Quality of life of people with chronic kidney disease.

The probability of not receiving KRT increases sharply from age 75 (Sparke et al. 2013). In 2013, the incidence of people not receiving KRT increased from 13 per 100,000 population in those aged 65–74, to 145 per 100,000 in those aged 75 and over (Figure 1).

Figure 1: Incidence of kidney failure with and without replacement therapy, by age, 2013

The bar chart shows the incidence rate of kidney failure 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 kidney failure 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 kidney failure 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 kidney failure incidence rates observed for males.

                 Download data

Incidence of kidney replacement therapy

An estimate of the incidence of KRT can be obtained from the ANZDATA Registry. This registry includes information on people who have had KRT in the form of dialysis or a kidney transplant. It does not contain information on people with kidney failure who do not receive KRT.

Not everyone with kidney failure chooses to receive KRT, opting instead for medical management, with a focus on quality of life and symptom control. Therefore, estimates of the total prevalence of kidney failure need to count cases of people who are receiving KRT and those who are not.

Estimating the true incidence of kidney failure in Australia requires linkage between ANZDATA and the National Death Index. This was most recently performed in 2013 and showed that of the 5,100 new cases of kidney failure in 2013, half (2,500) were not receiving treatment with KRT (AIHW 2016). Work is underway by the AIHW to update this linkage (see Data gaps and opportunities).

The total incidence of kidney failure (treated and untreated) is an indicator in the Australian Health Performance Framework (AIHW 2022).

Variation by age and sex

During 2020, 3,300 people with kidney failure started KRT in Australia, at an average of 9 people per day (ANZDATA 2021). Of these, 66% were aged under 70 and 64% were males.

In 2020, the incidence rate of KRT:

  • was 1.9 times as high in males as in females (age-standardised rate of 14.7 and 7.9 per 100,000 population, respectively)
  • increased with age, to be highest among men and women aged 75–79 (68 and 29 per 100,000 population, respectively) before falling among those aged 80–84 and 85 and over (Figure 2).

Figure 2: Incidence of kidney replacement therapy, by age and sex, 2020

The bar chart shows the number of new cases of kidney failure with replacement therapy, by age group and sex, for 2020. Males commenced KRT in 2020 at higher rates than females. For both sexes, the number of new cases of kidney failure with replacement therapy peaked in the 75-79 year age group. Prior to this age, the rate increased with age for males and females, and declined with age from 79.

                 Download data

Variation between population groups

Aboriginal and Torres Strait Islander people

Around 1,700 Indigenous Australians with kidney failure started KRT from 2016 to 2020, a rate of 41 per 100,000 population. There were 13,400 non-Indigenous Australians who started KRT during this time, a rate of 11 per 100,000 population.

Between 2016 and 2020, Indigenous males and females commenced KRT at a higher rate than their non-Indigenous counterparts (45 versus 7.6 per 100,000 population for females and 37 versus 15 per 100,000 population for males).

After adjusting for differences in the age structure of the populations:

  • the incidence rate of KRT among Indigenous Australians was 6.6 times as high as that for non-Indigenous Australians (64 and 9.7 per 100,000 population)
  • Indigenous females started KRT at a rate 10 times as high as that for non‑Indigenous females (67 and 6.5 per 100,000 population)
  • Indigenous males started KRT at a rate 4.7 times as high as that for non-Indigenous males (61 and 13 per 100,000 population) (Figure 3).

Treatment on Country

Treating and managing kidney failure among Indigenous Australians can be challenging, often due to difficulties associated with providing holistic health care that meets the medical, social and cultural needs of clients (Hughes et al. 2019).

Indigenous Australians may also have to leave their home, families and Country to access in-centre haemodialysis, adding to the challenges of treatment (Anderson et al. 2012). Providing dialysis services in remote regions of Australia has enabled more people to access care close to home. Between 2009 and 2016, there was a 42% increase in dialysis treatments delivered in Central Australia (Gorham et al. 2016).

In 2020, 26% of Indigenous Australians who received KRT (including kidney transplantation) did so close to home, with a large increase in the prevalence of peritoneal dialysis in the Northern Territory (ANZDATA 2021). In Central Australia, survival rates for haemodialysis are now higher than for the rest of Australia, going from the worst to the best in the country over the last 20 years (Gorham et al. 2016; UNE 2020).

Community-led services are making it easier for people to access care in their Country. Purple House is an Indigenous owned health service, providing remote dialysis, social support, aged care and National Disability Insurance Scheme services. It operates 18 dialysis units in Central Australia (Purple House 2022).

Remoteness and socioeconomic area

Data for 2016–2020 show that the incidence rate of KRT increased with socioeconomic disadvantage and was much higher in Remote and very remote areas.

After adjusting for differences in the age structure of the populations, rates were:

  • 2.1 times as high in Remote and very remote areas as in Major cities (40 and 19 per 100,000 population). Rates were 4.0 times as high among females (50 and 13 per 100,000 population, respectively), but only 1.2 times as high among males (32 and 25 per 100,000 population, respectively)
  • 1.9 times as high in the lowest socioeconomic areas as in the highest socioeconomic areas (15.4 and 8.2 per 100,000 population) (Figure 3).

Figure 3: Incidence of kidney replacement therapy, by population group, 2016–2020

The bar chart shows rates of new cases of kidney failure with replacement therapy by sex based on Aboriginal and Torres Strait Islander status, remoteness area and socioeconomic area. Indigenous people had commenced replacement therapy for kidney failure at rates 6.6 times higher than non-Indigenous people. Incidence rates for commencing KRT varied across remoteness areas, with the highest rates seen in Remote and Very remote areas, followed by Major cities. Incidence rates increased gradually by socioeconomic area, with people living in the least disadvantaged socioeconomic areas having the lowest incidence of kidney failure with replacement therapy, and those living in the most disadvantaged areas having the highest. Males commenced KRT for kidney failure at higher rates than females across all measures except for Indigenous females and females living in Remote and Very remote areas.

                 Download data

Trends over time

Between 2000 and 2020:

  • the number of people with kidney failure who started KRT rose from 1,800 to 3,300
  • the age-standardised incidence rates of KRT fluctuated between 9 and 12 per 100,000 population (Figure 4)
  • the incidence rate of KRT among males was 1.4 times as high as for females in 2000, increasing to 1.9 times as high in 2020.

Figure 4: Trends in the incidence of kidney replacement therapy, by sex, 2000 to 2020

The line chart shows the age-standardised trend in the incidence of kidney failure with replacement therapy, from 2000 to 2020, by sex. The incidence rate has remained stable for females over this time, and has increased by 34% for males, from 11 cases per 100,000 population in 2000 to 14.7 in 2020.

                 Download data

Prevalence of kidney replacement therapy

This section reports on the total number of people with kidney failure who received kidney replacement therapy (KRT) in Australia.

Variation by age and sex

At the end of 2020, 27,700 people with kidney failure had received KRT in Australia, of whom 61% (17,000) were males, and 71% (19,700) were aged under 70 (ANZDATA 2021a).

In 2020, the prevalence rate of KRT:

  • was 1.7 times as high in males as in females (age-standardised rates of 120 and 72 per 100,000 population)
  • increased with age, to be highest among men aged 80–84 (414 per 100,000 population) and women aged 65–69 (214 per 100,000 population), but then falling for age 85 and over for both sexes (Figure 5).

Figure 5: Prevalence of kidney replacement therapy, by age and sex, 2020

The bar chart shows the total prevalence rate of kidney failure with replacement therapy by age and sex in 2020. Across all ages, more males than females were receiving KRT. The overall prevalence increased with increasing age until age 85+, where it decreased to a similar rate as that seen in the 45-49 year age group.

                 Download data

Type of kidney replacement therapy

The type of KRT received varies according to age. In 2020, people with kidney failure aged under 55 were more likely to have a functioning kidney transplant than undergo dialysis (Figure 6).

Between ages 55 and 64, approximately half of the people receiving KRT had a functioning kidney transplant (52%), and half received dialysis.

After age 65, people with kidney failure were more likely to receive dialysis than have a functioning kidney transplant, with the proportion of people on dialysis rising sharply from age 75.

Figure 6: Prevalence of kidney replacement therapy, by type and age, 2020

The bar chart shows the total prevalence of kidney failure with replacement therapy by age and type of KRT (dialysis or transplant). The general pattern shows that the percentage of people treated with a transplant decreases with age, while dialysis increases. Transplants were the most common for of KRT for those aged 0-64, with those aged 0-24 having the highest rate of treatment with transplants (75%). Dialysis was the most common form of KRT in those aged 65 and over, increasing with age. 93% of those aged 85+ receiving KRT were treated with dialysis. For those aged 55-64, the prevalence of dialysis and transplants was similar (52% and 48%, respectively).

                 Download data

Variation between population groups

Aboriginal and Torres Strait Islander people

Indigenous Australians with kidney failure are more likely to receive dialysis than a kidney transplant, while non-Indigenous Australians with kidney failure are equally likely to receive either KRT type (Figure 7).

In 2020, 2,500 Indigenous Australians with kidney failure received KRT, with 85% undergoing dialysis and 15% having a kidney transplant.

In comparison, 51% of non-Indigenous Australians with kidney failure received dialysis and 49% had a kidney transplant.

Figure 7: Trends in prevalence of kidney replacement therapy, by Indigenous status and type, 2000 to 2020

The line chart shows the age-standardised trend in the type of KRT received by people with kidney failure with replacement therapy from 2000 to 2020, by Aboriginal and Torres Strait Islander status. Over this time, non-Indigenous Australians were equally likely to receive dialysis or a transplant, with the widest gap being in 2007, when 56% of people were treated with dialysis. Among Indigenous Australians, people were consistently more likely to be treated with dialysis, with between 80 and 90% of people treated with dialysis across the 20 years, compared to 10-20% who were treated with a transplant.

                 Download data

Around 2,500 Indigenous Australians and 23,900 non-Indigenous Australians with kidney failure received KRT in 2020, at a rate of 284 and 96 per 100,000 population, respectively. Indigenous females and males received KRT at a higher rate than their non-Indigenous counterparts (311and 71 per 100,000 population for females, 256 and 122 per 100,000 population for males).

After adjusting for differences in the age structure of the populations:

  • the prevalence rate of KRT among Indigenous Australians was 5.3 times as high as that for non-Indigenous Australians (443 and 83 per 100,000 population)
  • Indigenous females received KRT at a rate that was 7.7 times as high as that for non‑Indigenous females (464 and 60 per 100,000 population)
  • Indigenous males received KRT at a rate that was 3.9 times as high as that for non‑Indigenous males (418 and 108 per 100,000 population) (Figure 8).

Remoteness and socioeconomic area

Data for 2020 show that the prevalence rate of KRT increased with socioeconomic disadvantage, and was highest in Remote and very remote areas.

After adjusting for differences in the age structure of the populations, rates were:

  • 2.6 times as high in Remote and very remote areas as in Major cities (249 and 94 per 100,000 population). Rates were 4.5 times as high for females (305 and 68 per 100,000 population) and 1.6 as high for males (201and 122 per 100,000 population)
  • 1.7 times as high in the lowest socioeconomic areas as in the highest socioeconomic areas (122 and 74 per 100,000 population) (Figure 8).

Figure 8: Prevalence of kidney replacement therapy, by population group and sex, 2020

The bar chart shows rates of kidney failure with replacement therapy by sex based on Aboriginal and Torres Strait Islander status, remoteness area and socioeconomic area. Indigenous people received replacement therapy for kidney failure at rates 5.3 times higher than non-Indigenous people. Prevalence rates for KRT were similar across remoteness areas, with the exception of Remote and Very remote areas, which had rates 2.6 times higher than in Major cities. Prevalence rates increased gradually by socioeconomic area, with people living in the least disadvantaged socioeconomic areas having the lowest prevalence of kidney failure with replacement therapy, and those living in the most disadvantaged areas having the highest. Males received KRT for kidney failure at higher rates than females across all measures except for Indigenous females and females living in Remote and Very remote areas.

                 Download data

Trends over time

Between 2000 and 2020:

  • the number of people with kidney failure receiving KRT increased by 136%, from 11,700 to 27,700
  • the age-standardised prevalence rate of KRT increased by 55%, from 62 to 95 per 100,000 population (Figure 9)
  • the age-standardised prevalence rate of KRT among males compared with females increased from 1.4 times as high (73 and 51 per 100,000 population) to 1.7 times as high (120 and 72 per 100,000 population).

People with kidney failure receiving KRT are about equally likely to receive dialysis or a kidney transplant (Figure 9(b)). Dialysis was slightly more common than kidney transplantation in 2020 (53% and 47%), with the largest difference in the 2 types seen between 2005 and 2010.

Figure 9 and 9(b): Trends in prevalence of kidney replacement therapy, by sex and type

The first line chart shows the age-standardised prevalence rate of kidney failure with replacement therapy, by sex, from 2000 to 2020. The prevalence increased steadily for males and females, growing by 66% for males and 41% for females.

The second line chart shows the age-standardised prevalence rate of kidney failure with replacement therapy, by the type of KRT, from 1989 to 2020. In 1989, transplants were the most common form of KRT (53%). In 1994, treatment was 50% transplants and 50% dialysis, and dialysis has remained the most common type of KRT from 1995 onwards. The proportion of cases treated with dialysis peaked in 2007, at 57%. Since 2007, the proportions have evened out, with 53% of cases treated with dialysis in 2020.

                 Download data