Hospital care for chronic kidney disease

All chronic kidney disease

There were approximately 1.8 million hospitalisations where chronic kidney disease was recorded as the principal and/or additional diagnosis in 2016–17, according to the AIHW National Hospital Morbidity Database. This represents 16% of all hospitalisations in Australia. Dialysis accounted for the vast majority (80%) 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 2016–17 there were around:

  • 47,900 hospitalisations with CKD (excluding dialysis) as the principal diagnosis (the diagnosis largely responsible for hospitalisation). 
  • 309,300 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) almost doubled between 2000–01 and 2016–17, from 24,100 to 47,900 hospitalisations. Over this same period, the age-standardised rate increased by 47% (126 and 185 per 100,000 population, respectively) (Figure 1).

Figure 1: Trends in CKD hospitalisations as the principal diagnosis (excluding dialysis), by sex, 2000–01 to 2016–17

The trends in CKD hospitalisations have increased from 127 hospitalisations per 100,000 people for males and 128 hospitalisations per 100,000 people for females in 2000-01, to 182 hospitalisations per 100,000 people for males, and 192 for hospitalisations per 100,000 people for females in 2016-17.

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.

Chart: AIHW. Source: AIHW analysis of the National Morbidity Database. (Data table)

Hospitalisations with CKD as the 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 2016–17 were:

  • diseases of the circulatory system (19%)
  • diseases of the respiratory system (9%)
  • diseases of the genitourinary system (8%).

Age and sex

In 2016–17, CKD hospitalisation rates (as the principal or additional diagnosis):

  • were similar for males and females (182 per 100,000 and 192 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 (70%) occurring in those aged 65 and over. CKD hospitalisation rates for males and females were highest in those aged 85 and over (19,000 and 10,800 per 100,000 population, respectively)—at least 1.6 times as high as those in the 75–84 age group (11,300 and 6,800 per 100,000) (Figure 2).

Figure 2: CKD hospitalisations (principal or additional diagnosis), by age and sex, 2016–17

CKD hospitalisations increased with each age group. Males are consistently higher than females. Males increased from 4,700 hospitalisations per 100,000 population to 19,000 hospitalisations per 100,000 population. Females increased from 2,800 in the 65-74 year age group to 10,800 hospitalisations per 100,000 population in the 85+ year age group.

Chart: AIHW. Source: AIHW analysis of the National Hospital Morbidity Database. (Data table)

Variation among population groups

In 2016–17, 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:

  • 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—4 times as high for females (3,900 compared with 997 per 100,000 population) and 2 times as high for males (2,700 compared with 1,500 per 100,000) (Figure 3).
  • twice as high in the lowest socioeconomic group compared with the highest socioeconomic group (based on area of usual residence)—over 2 times as high for females (1,500 compared with 691 per 100,000) and almost twice as high for males (2,000 compared with 1,100 per 100,000) (Figure 3).

Figure 3: CKD hospitalisations (principal or additional diagnosis), by remoteness and socioeconomic group, 2016–17

CKD hospitalisations were highest in remote and very remote areas for females 38,600 hospitalisations per 100,000 population and males 2,700 hospitalisations per 100,000 population. CKD hospitalisations were highest in the lowest socioeconomic group for both males (2000 hospitalisations per 100,000 population) and females (1500 hospitalisations per 100,000 population).

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

Chart: AIHW. Source: AIHW analysis of the National Hospital Morbidity Database. (Data table)

Aboriginal and Torres Strait Islander people

In 2016–17, there were around 25,200 hospitalisations for CKD (as the principal or additional diagnosis) among Aboriginal and Torres Strait Islander people, a rate of 6,100 per 100,000 population.

  • The rate among Indigenous Australians was 5 times as high as the non-Indigenous rate.
  • 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 (6,800 compared with 950 per 100,000) and almost 4 times as high for males (5,300 compared with 1,400 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 2016–17. 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 145% between 2000–01 and 2016–17, from 582,400 to 1.4 million hospitalisations. In addition, the age-standardised rate increased by more than 70%, from 3,100 to 5,300 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), 2000–01 to 2016–17

Regular dialysis hospitalisations increased for males from 3,900 hospitalisations per 100,000 population in 200-01 to 6,500 hospitalisations per 100,000 population in 2016-17. During the same period they also increased for females from 2,500 hospitalisations per 100,000 population to 4,100 hospitalisations per 100,000 population.

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

Chart: AIHW. Source: AIHW analysis of the National Morbidity Database. (Data table)

Age and sex

In 2016–17, 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 (Figure 5).
  • increased with age up to 85 years, 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 years (41,300 and 20,700 per 100,000 population) (Figure 5).

Figure 5: Regular dialysis hospitalisations (principal diagnosis), by age and sex, 2016–17

Remote and very remote areas have a higher incidence of treated ESKD (41 for females and 26 for males per 100,000 population) than major cities (14 for males and 7 for females).

Chart: AIHW. Source: AIHW analysis of the National Hospital Morbidity Database. (Data table)

Variation among population groups

In 2016–17, 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 gap in these rates was much larger for females than males—8 times as high for females (29,400 compared with 3,600 per 100,000 population) and 2.5 times as high for males (16,600 compared with 6,800 per 100,000) (Figure 6). 
  • more than twice as high in the lowest socioeconomic group compared with the highest socioeconomic group (based on area of usual residence)—3 times as high for females (7,100 compared with 2,400 per 100,000) and almost 2 times as high for males (9,300 compared with 5,000 per 100,000) (Figure 6).

Figure 6: Regular dialysis hospitalisations (principal diagnosis), by remoteness and socioeconomic group, 2016–17

Regular dialysis hospitalisations were highest for females in remote and very remote areas with 29,400 hospitalisations per 100,000 population. This was also true for males with 16,600 hospitalisations per 100,000 population.

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

Chart: AIHW. Source: AIHW analysis of the National Hospital Morbidity Database. (Data table)

Aboriginal and Torres Strait Islander people

In 2016–17, there were 237,200 hospitalisations for regular dialysis (as the principal diagnosis) among Aboriginal and Torres Strait Islander people, a rate of 51,700 per 100,000 population.

After adjusting for the difference in the age structure of the population groups:

  • The rate among Indigenous Australians was 12 times as high as the non-Indigenous rate.
  • The disparity between Indigenous Australians and non-Indigenous Australians was greater for females than males—19 times as high for females and 8 times as high for males.