Hospital care for chronic kidney disease

All chronic kidney disease

There were approximately 1.8 million hospitalisations where chronic kidney disease (CKD) was recorded as the principal and/or additional diagnosis in 2017–18, according to the Australian Institute of Health and Welfare National Hospital Morbidity Database. This represents 16% of all hospitalisations in Australia. Dialysis accounted for the vast majority (79%) 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 2017–18 there were around:

  • 51,300 hospitalisations with CKD (excluding regular dialysis) as a principal diagnosis— the diagnosis largely responsible for hospitalisation. 
  • 315,700 hospitalisations with CKD (excluding regular 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 a principal diagnosis only (13% of all hospitalisations in Australia).

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

The number of hospitalisations for CKD as a principal diagnosis (excluding regular dialysis) more than doubled between 2000–01 and 2017–18, from 24,100 to 51,300 hospitalisations. Over this same period, the age-standardised rate increased by 54% (126 and 194 per 100,000 population, respectively) (Figure 1).

Figure 1: Trends in CKD hospitalisations as a principal diagnosis (excluding regular dialysis), by sex, 2000–01 to 2017–18

The line graph shows that, between 2000–01 and 2017–18, the age-standardised rate of CKD hospitalisations as the principal diagnosis (excluding dialysis) increased. For males, the rate increased from 127 to 190 hospitalisations per 100,000 population, while for females it increased from 128 to 202 hospitalisations per 100,000.

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CKD hospitalisations as a principal 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 2017–18 were:

  • diseases of the circulatory system (18%)
  • injury, poisoning and certain consequences of external causes (10%)
  • diseases of the respiratory system (9.8%)
  • diseases of the genitourinary system (8.2%).

Age and sex

In 2017–18, CKD hospitalisation rates (as a principal or additional diagnosis):

  • were between 1.3 and 2 times higher for females than males before the age of 45. From age 45, age-specific rates were higher for males than females.
  • increased with age, with the majority (70%) occurring in those aged 65 and over. CKD hospitalisation rates for males and females were highest in those aged 85 and over (19,100 and 11,000 per 100,000 population, respectively)—at least 1.6 times as high as those in the 75–84 age group (11,100 and 6,900 per 100,000, respectively) (Figure 2).

Figure 2: CKD hospitalisation rates as a principal or additional diagnosis (excluding regular dialysis), by age group and sex, 2017–18

The butterfly graph shows that CKD hospitalisation rates increased with each age group. From ages 45 and over, male hospitalisation rates were consistently higher than the female rates. The rate for males aged 65–74 was 4,700 hospitalisations per 100,000 population compared with 19,100 per 100,000 population for those aged 85 and over. For females, aged 65–74 the rate was 2,800 hospitalisations per 100,000 compared with 11,000 per 100,000 population for those aged 85 and over.

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Variations between population groups

In 2017–18, CKD hospitalisation rates (as the principal or additional diagnosis, excluding regular dialysis) increased with remoteness and socioeconomic disadvantage.

After adjusting for differences in the age structure of the population groups, CKD hospitalisation rates were:

  • 2.7 times as high for people living in Remote and very remote areas compared with Major cities. The difference in these rates was much larger for females than males—4 times as high for females (4,100 and 1,000 per 100,000 population, respectively) and 1.8 times as high for males (2,700 and 1,500 per 100,000, respectively).
  • twice as high for poeple living in the lowest socioeconomic areas compared with those living in the highest socioeconomic areas—over twice as high for females (1,600 and 700 per 100,000) and almost twice as high for males (2,000 compared with 1,000 per 100,000, respectively) (Figure 3).

Figure 3: CKD hospitalisation rates as a principal or additional diagnosis (excluding regular dialysis), by remoteness and socioeconomic area, 2017–18

The bar graph shows that the age-standardised rates of CKD hospitalisations were higher in Remote and very remote areas for both females and males (4,100 and 2,700 hospitalisations per 100,000 population, respectively) than in Major cities (1,500 and 1,000 hospitalisations per 100,000, respectively). CKD hospitalisation rates were the highest in the most disadvantaged socioeconomic area for both males (2,000 hospitalisations per 100,000 population) and females (1,600 hospitalisations per 100,000 population).

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Aboriginal and Torres Strait Islander people

In 2017–18, there were around 27,000 hospitalisations for CKD (as the principal or an additional diagnosis) among Aboriginal and Torres Strait Islander people, a rate of 3,300 per 100,000 population.

After adjusting for differences in the age structure between the two population groups:

  • The rate among Indigenous Australians was almost 5 times the rate among non-Indigenous Australians (5,700 and 1,200 per 100,000, respectively).
  • The differences in CKD hospitalisation rates between Indigenous and non-Indigenous Australians were greater for females than males— almost 7 times as high for females (6,300 and 954 per 100,000, respectively) and almost 4 times as high for males (5,100 and 1,400 per 100,000, respectively).

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 2017–18.

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 144% between 2000–01 and 2017–18, from 582,400 to 1.4 million hospitalisations. In addition, the age-standardised rate increased by more than 67%, from 3,100 to 5,100 per 100,000 population (Figure 4).

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

Figure 4: Trends in hospitalisation rates for regular dialysis (principal diagnosis), by sex, 2000–01 to 2017–18

The line graph shows that regular dialysis hospitalisations increased for both males and females (from 3,700 hospitalisations per 100,000 population in 2000–01 to 6,300 hospitalisations in 2017–18 for males and from 2,500 per 100,000 population in 2000–01 to 4,000 hospitalisations in 2017–18, for females respectively).

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Age and sex

In 2017–18, CKD hospitalisation rates for regular dialysis (as the principal diagnosis):

  • were 1.6 times as high among males as females. Age-specific rates for males were higher than females across all age groups.
  • increased with age up to 75–84, with three-in-four (76%) 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 (39,100 and 19,800 per 100,000 population, respectively) (Figure 5).

Figure 5: Hospitalisation rates for regular dialysis (principal diagnosis), by age group and sex, 2017–18

The butterfly graph shows that rates of regular dialysis hospitalisations were consistently higher for males than females, and increased with age until the 75-84 age group, then dropped from ages 85 and over. For males, there were 11,700 hospitalisations per 100,000 population for the 55–64 age group, increasing to 39,100 hospitalisations per 100,000 for the 75–84 age group. This decreased to 28,000 hospitalisations per 100,000 population for the 85 and over age group. For females, there were 8,700 hospitalisations per 100,000 population for the 55–64 age group, increasing to 19,800 hospitalisations per 100,000 the 75–84 age group and decreasing to 8,600 hospitalisations per 100,000 population for the 85 and over age group.

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Variations between population groups

In 2017–18, CKD hospitalisation rates for regular dialysis (as the principal diagnosis) increased with remoteness and socioeconomic disadvantage.

After adjusting for the difference in the age structure of the population groups, CKD hospitalisation rates were:

  • more than 4 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— nearly 8 times as high for females (26,900 and 3,500 per 100,000 population, respectively) and 2.5 times as high for males (16,100 and 6,400 per 100,000, respectively).
  • more than twice as high for people living in the lowest socioeconomic areas compared with those living in the highest socioeconomic areas—3 times as high for females (7,000 and 2,300 per 100,000, respectively) and 2 times as high for males (9,300 and 4,600 per 100,000, respectively) (Figure 6).

Figure 6: Hospitalisation rates for regular dialysis (principal diagnosis), by remoteness and socioeconomic area, 2017–18

The bar graph shows that Remote and very remote areas had the highest rates of regular dialysis hospitalisations. Females in Remote and very remote areas had an age-standardised rate of 26,900 hospitalisations per 100,000 population and males had a rate of 16,100 hospitalisations per 100,000 population. In contrast, both females and males living in Major cities had lower rates of regular dialysis hospitalisations, (6, 400 hospitalisations for males and 3,400 for females per 100,000 respectively).
Similarly, people living in the most disadvantaged socioeconomic area had the highest rates regular dialysis hospitalisations,(with rates of 9,300 and 6,900 per 100,000 population for males and females respectively) compared with males and females in the least disadvantaged socioeconomic area (4,500 hospitalisations and 2,300 hospitalisations per 100,000 population, respectively.

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Aboriginal and Torres Strait Islander people

In 2017–18, there were 233,900 hospitalisations for regular dialysis (as the principal diagnosis) among Aboriginal and Torres Strait Islander people a rate of 28,400 per 100,000 population.

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

  • The rate among Indigenous Australians was almost 11 times as high as the rate for non-Indigenous Australians (45,200 and 4,200 per 100,000, respectively).

  • The disparity between Indigenous and non-Indigenous Australians was greater for females than males—16 times as high for females (48,800 and 3,000 per 100,000, respectively) and over 7 times as high for males (41,300 and 5,500 per 100,000, respectively).