Hospital care for chronic kidney disease

All chronic kidney disease

There were approximately 1.7 million hospitalisations where chronic kidney disease was recorded as the principal and/or additional diagnosis in 2015–16, according to the AIHW National Hospital Morbidity Database. This represents 16% of all hospitalisations in Australia. Dialysis accounted for the vast majority (81%) of these hospitalisations. Note that hospitalisation data presented here are based on admitted patient episodes of care, including multiple events experienced by the same individual.

In 2015–16 there were around:

  • 42,800 hospitalisations with CKD (excluding dialysis) as the principal diagnosis (the diagnosis largely responsible for hospitalisation)
  • 293,500 hospitalisations with CKD (excluding dialysis) as an additional diagnosis (a coexisting condition with the principal diagnosis or a condition arising during hospitalisation that affects patient management).
  • 1.4 million hospitalisations for regular dialysis as the principal diagnosis only (13% of all hospitalisations in Australia).

Trends for CKD as the principal diagnosis (excluding regular dialysis)

The number of hospitalisations for CKD as the principal diagnosis (excluding regular dialysis) increased by 51% between 2005–06 and 2015–16, from 28,800 to 43,600 hospitalisations. Over this same period, the age-standardised rate increased by 22% (138 and 169 per 100,000 population, respectively) (Figure 1).

Figure 1: Trends in CKD hospitalisations as the principal diagnosis (excluding dialysis), by sex, 2005–06 to 2015–16

The line chart shows that between 2005–06 and 2015–16, the number of hospitalisations for CKD increased. Rates were very similar for males and females over this period.  

Notes  

  1. Age-standardised to the 2001 Australian Standard Population.
  2. The drop in the male rate in 2010–11 was due to a change in the coding of diabetes in hospital data (see data table for more details).

Source: AIHW National Hospital Morbidity Database (Data table).

CKD hospitalisations as the principal and/or additional diagnosis

When CKD coexists with a different principal diagnosis but affects patient care during hospitalisation, it is recorded as an additional diagnosis. Excluding regular dialysis, CKD is more often coded as an additional diagnosis.

Where CKD was listed as an additional diagnosis, the leading principal diagnoses in 2015–16 were:

  • diseases of the circulatory system (20%)
  • diseases of the respiratory system (9%)
  • diseases of the genitourinary system (9%).

Age and sex

In 2015–16, CKD hospitalisation rates (as the principal and/or additional diagnosis):

  • Were overall similar for males and females (169 per 100,000 and 174 per 100,000 population, respectively). From age 45, age-specific rates were higher for males than females. (Figure 2).
  • Increased with age, with the majority (69%) occurring in those aged 65 and over. CKD hospitalisation rates for males and females were highest in those aged 85 and over (18,616 and 10,508 per 100,000 population, respectively)—at least 1.6 times as high as those in the 75–84 age group (11,010 and 6,620 per 100,000) (Figure 2).

Figure 2: CKD hospitalisations (principal and/or additional diagnosis), by age and sex, 2014–15

The vertical bar chart shows that hospitalisation rates for CKD as a principal and/or additional diagnosis increased steadily with age for both males and females—rates were the highest in those aged 85 and over, at least 1.6 times as high as rate in the 75–84 age group.  

Source: AIHW National Hospital Morbidity Database (Data table).

Variations among population groups

In 2015–16, CKD hospitalisation rates (as the principal and/or additional diagnosis, excluding regular dialysis) increased with remoteness and socioeconomic disadvantage:

  • 2.3 times as high in Remote and very remote areas compared with Major Cities. The difference in these rates was much larger for females than males—3.7 times as high for females (3,552 compared with 973 per 100,000 population) and 1.4 times as high for males (2,161 compared with 1,497 per 100,000) (Figure 3).
  • 1.9 times as high in the lowest socioeconomic group compared with the highest socioeconomic group (based on area of usual residence)—2.1 times as high for females (1,418 compared with 677 per 100,000) and 1.7 times as high for males (1,838 compared with 1,099 per 100,000) (Figure 3).

Figure 3: CKD hospitalisations (principal and/or additional diagnosis), by remoteness and socioeconomic group, 2015–16

The horizontal bar chart shows that in 2015–16, CKD hospitalisation rates in Remote/Very remote areas were 3 times as high for females & 1.5 times as high for males when compared to Major cities. Similarly, rates in the lowest socioeconomic group (group 1) compared to the highest socioeconomic group (group 5) were 2.1 times as high for females and 1.7 times as high for males.

Note: Age-standardised to the 2001 Australian Standard Population.

Source: AIHW National Hospital Morbidity Database (Data table).

Aboriginal and Torres Strait Islander people

In 2015–16, there were around 23,100 hospitalisations for CKD (as the principal and/or additional diagnosis) among Aboriginal and Torres Strait Islander people, a rate of 5,622 per 100,000 population.

  • The rate among Indigenous Australians was overall 5 times as high as the non-Indigenous rate (5,622 compared with 1,128 per 100,000 population).
  • The disparity in CKD hospitalisation rates between Indigenous Australians and non-Indigenous Australians was greater for females than males—7 times as high for females (6,288 compared with 944 per 100,000) and 4 times as high for males (4,898 compared with 1,337 per 100,000).

Regular dialysis

Dialysis is the most common reason for hospitalisation in Australia, accounting for 1.4 million hospitalisations for CKD as the principal diagnosis (13% of all hospitalisations) in 2015–16. Hospitalisations data count the number of dialysis episodes rather than the number of people who receive dialysis. On average, dialysis patients attend 3 sessions per week. For information on how many people receive dialysis, see Australia and New Zealand Dialysis and Transplant Registry (ANZDATA).

Trends

The number of hospitalisations for regular dialysis increased by 58% between 2005–06 and 2015–16, from 884,000 to 1.4 million hospitalisations. In addition, the age-standardised rate increased by 24%, from 4,211 to 5,226 per 100,000 population (Figure 4).

The rate of hospitalisations for regular dialysis among males was consistently higher than that for females over the period, with both showing similar trends and rates of increase.

Figure 4: Trends in regular dialysis hospitalisations (principal diagnosis), 2005–06 to 2015–16

The line chart shows that between 2005–06 and 2015–16, the number of regular dialysis hospitalisations (as a principal diagnosis) increased. Rates have been consistently higher for males than females over this period.

Note: Age-standardised to the 2001 Australian Standard Population.

Source: AIHW National Hospital Morbidity Database (Data table).

Age and sex

In 2015–16, CKD hospitalisation rates for regular dialysis (as the principal diagnosis):

  • Were overall 1.6 times as high among males as females. Age-specific rates for males were higher than females across all age groups (Figure 5).
  • Increased with age up to age 85, with three-in-four (75%) hospitalisations occurring in those aged 55 and over. CKD hospitalisation rates for regular dialysis for males and females were highest in those aged 75–84 years (42,032 and 20,462 per 100,000 population) (Figure 5).

Figure 5: Regular dialysis hospitalisations (principal diagnosis), by age and sex, 2015–16

The vertical bar chart shows that in 2015–16, regular dialysis hospitalisations (as a principal diagnosis) increased with age for both males and females up to age 84. Rates were highest in those aged 75–84 years for both males and females. Males had consistently higher rates than females across all age groups.

Source: AIHW National Hospital Morbidity Database (Data table).

Variations among population groups

In 2015–16, CKD hospitalisation rates for regular dialysis (as the principal diagnosis) increased with remoteness and socioeconomic disadvantage:

  • 4 times as high in Remote and very remote areas compared with Major cities. The gap in these rates was much larger for females than males—8 times as high for females (28,478 compared with 3,633 per 100,000 population) and 2 times as high for males (13,791 compared with 6,802 per 100,000) (Figure 6). 
  • 2.1 times as high in the lowest socioeconomic group compared with the highest socioeconomic group (based on area of usual residence)—2.7 times as high for females (6,832 compared with 2,509 per 100,000) and 1.8 times as high for males (8,954 compared with 5,087 per 100,000) (Figure 6).

Figure 6: Regular dialysis hospitalisations (principal diagnosis), by remoteness and socioeconomic group, 2015–16

The horizontal bar chart shows that in 2015–16, CKD hospitalisation rates for regular dialysis (as a principal diagnosis) in Remote/Very remote areas compared with Major cities were 5 times as high for females and 1.5 times as high for males. CKD hospitalisation rates for the lowest socioeconomic group (group 1) compared to the highest socioeconomic group (group 5) were 2.6 times as high for females and 1.7 times as high for males. Males had consistently higher rates than females.

Note: Age-standardised to the 2001 Australian Standard Population.

Source: AIHW National Hospital Morbidity Database (Data table).

Aboriginal and Torres Strait Islander people

In 2015–16, there were 224,000 hospitalisations for regular dialysis (as the principal diagnosis) among Aboriginal and Torres Strait Islander people, a rate of 53,069 per 100,000 population.

  • The rate among Indigenous Australians was overall 12 times as high as the non-Indigenous rate (53,069 compared with 4,272 per 100,000 population).
  • The disparity between Indigenous Australians and non-Indigenous Australians was greater for females than males—19 times as high for females (59,792 compared with 3,087 per 100,000) and 8 times as high for males (45,580 compared with 5,575 per 100,000).