How many Australians have chronic kidney disease?

All chronic kidney disease

An estimated 1.7 million (10%) Australian adults aged 18 years and over had biomedical signs of chronic kidney disease (CKD) in 2011–12, based on measured data from the Australian Bureau of Statistics (ABS) 2011–12 Australian Health Survey.

The vast majority of these (97%) showed early signs of the disease (stages 1–3). CKD remains a highly under-diagnosed condition―only 10% of the survey respondents who showed biomedical signs of CKD also self-reported that they had the condition. Therefore, this section reports measured data from the ABS 2011–12 Australian Health Survey instead of self-reported data from the more recent ABS 2017–18 National Healthy Survey.

In 2011–12, the prevalence of biomedical signs of CKD among adults:

  • was similar for men and women (10% for both)
  • increased rapidly after age 74, with rates among those aged 75 and over twice as high (42%) as for those aged 65–74 (21%) and around 7 times as high as for those aged 18–54 (6%) (Figure 1).

Figure 1: Prevalence of CKD, among people aged 18 and over, by age group and sex, 2011–12

The column graph shows the increase in the prevalence of chronic kidney disease (CKD) in 2011–12 by age group.  The prevalence of CKD was higher for males than females in all groups, except for the 18–44 age group where females (6.2%) had a higher prevalence than males (4.5%). The prevalence increased from 9.1% for males and 6.3% for females in the 55–64 age group, to 26% for men and 16% for females in the 65–74 age group, increasing again to 43% for men and 42% for females in the 75and over age group.

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Change over time

Between 1999–2000 and 2011–12, the CKD prevalence rate remained stable, at around 10% among adults aged 25 and over. There was no difference between men and women in the prevalence of CKD in both surveys.

The number of Australians with a moderate-to-severe loss of kidney function (stages 3–5) nearly doubled over this period (from 322,000 in 1999–2000 to 604,000 in 2011–12) (AIHW 2018). This increase was mostly driven by an increase in CKD stage 3 due to growth in the size of the population aged 65 and over.

Variation between population groups

In 2011–12, the prevalence of biomedical signs of CKD among adults was similar across remoteness areas, but increased with socioeconomic disadvantage (Figure 2).
Proportions were:

  • similar in Major cities (10%), Inner regional (11%) and Outer regional and remote (8.7%) areas
  • highest among those in the lowest socioeconomic area (14%) compared with those in the highest socioeconomic area (8.3%).

Figure 2: Prevalence of CKD, for persons aged 18 and over, by remoteness and socioeconomic area, 2011–12

The bar graph shows that the prevalence of CKD was similar across all remoteness areas for males and females. Those living in the most disadvantaged socioeconomic areas had the highest prevalence with 14% for males and 13% for females, compared to the males and females in the least disadvantaged with the lowest prevalence rates of 7.9% and 8.9%, respectively.

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Aboriginal and Torres Strait Islander people

An estimated 1 in 5 (18%) Indigenous adults (59,600 people) had biomedical signs of CKD, according to the ABS 2012–13 National Aboriginal and Torres Strait Islander Health Measures Survey.

Indigenous adults were twice as likely to have biomedical signs of CKD as non-Indigenous adults (22% and 10%, respectively), after taking into account differences in the age structure of the populations.

Treated end-stage kidney disease

Information on the prevalence and incidence of people with end-stage kidney disease (ESKD) can be obtained from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). This registry includes people who receive kidney replacement therapy (KRT) in the form of a kidney transplant or dialysis, but does not contain information on those people with ESKD who do not receive KRT.

This section reports the incidence and trends of new patients with end-stage disease receiving KRT registered in the ANZDATA.

ESKD is the most severe form of chronic kidney disease. Only half of people with ESKD undertake KRT, as other strategies may be more suited for patients receiving end-of-life medical care (AIHW 2016).

In 2018, there were around 3,100 new cases of treated ESKD in Australia. This equates to 8 cases diagnosed every day, or an incidence rate of 11 cases per 100,000 population.

The leading causes of ESKD among new patients were:

  • diabetes (38%)
  • glomerulonephritis—a type of kidney inflammation (16%)
  • hypertension (13%)
  • polycystic disease—presence of multiple cysts in the kidney (6.6%).

Trends by age and sex

Age standardised incidence rates of treated ESKD have almost doubled from 6 persons per 100,000 population in 1989 to 11 persons per 100,000 in 2018. This increase was greater for males, from 6 cases per 100,000 population in 1989 to 15 cases per 100,000 in 2018, than for females, increasing from 5 to 8 cases per 100,000 population from 1989 to 2018 (Figure 3).

Since 2006, the incidence rate has remained largely unchanged among both males and females.

Figure 3: Trends in the rate of new treated cases of ESKD, by sex, 1989 to 2018

The line graph shows that, between 1989 and 2018, the age-standardised incidence rate of treated ESKD among person has increased from 6 to 11 per 100,000 population. Over the same period, the rate among males increased from 6 to 15 per 100,000 population and for females increased from 5 to 8 per 100,000 population. Since 2006, the incidence rate of treated ESKD has remained largely unchanged for both males and females.

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In 2018, the age-specific incidence rates for treated ESKD were higher for males than females across all age groups.

Incidence rates increased with age. The rates for males aged 65–74 and 75 and over were almost 2 times as high as 55–64 year olds, and over 8 times as high as 0–54 year olds.

Females aged 65–74 had the highest rate, at 1.4 times as high as 55–64 year olds and 5.6 times as high for females aged under 55. In contrast, females aged 75 and over had slightly lower incidence rates than those aged 65–74 (19 and 25 per 100,000, respectively) (Figure 4).

Figure 4: Incidence of treated ESKD, by age group and sex, 2018

The butterfly graph shows that the incidence of treated end-stage kidney disease (ESKD) was consistently higher for males than females. The incidence increased for males from 28 per 100,000 population in the 55–64 age group to 54 per 100,000 population in the 75 and over age group. For females, it increased from 18 per 100,000 population in the 55–64 age group to 25 in the 65–74 age group before decreasing to 19 per 100,000 population in the 75 and over age group.

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Variations between population groups

Between 2014–2018, the incidence of treated cases of ESKD increased with remoteness and socioeconomic disadvantage.

After adjusting for differences in age structure between population groups, the incidence rates were:

  • 3.5 times as high in Remote and very remote areas compared with Major cities— almost 7 times as high for females (47 and 7 per 100,000 population, respectively) and twice as high for males (30 and 14 per 100,000, respectively).

  • 1.9 times as high in the lowest socioeconomic areas compared with the highest socioeconomic areas— 2.3 times as high for females (12 and 5 per 100,000, respectively) and 1.7 times as high for males (18 and 11 per 100,000, respectively) (Figure 5).

Figure 5: Incidence of treated ESKD, by remoteness and socioeconomic area, 2014–2018

The bar graph shows that Remote and very remote areas have a higher age-standardised incidence rate of treated ESKD (47 for females and 30 for males per 100,000 population) than Major cities (14 for males and 7 for females). It also shows that the people living in the most disadvantaged socioeconomic areas have a higher age-standardised incidence rate of treated ESKD (18 for males and 12 for females per 100,000 population) than those living in the least disadvantaged socioeconomic areas (11 for males and 5 for females).

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Aboriginal and Torres Strait Islander people

Between 2014–2018, the incidence rate of treated ESKD was 39 per 100,000 among Indigenous Australians. After adjusting for the difference in the age structure of the populations:

  • The rate among Indigenous Australians was almost 7 times the rate for non-Indigenous Australians (63 and 9 per 100,000, respectively).
  • The differences between Indigenous Australians and non-Indigenous Australians were greater for females than males—almost 11 times as high for females (66 and 6 per 100,000, respectively) and almost 5 times as high for males (58 and13 per 100,000, respectively).

References

AIHW (Australian Institute of Health and Welfare) 2016. Incidence of end-stage kidney disease in Australia 1997–2013. Cat. no. PHE 211. Canberra: AIHW.

AIHW 2018. Chronic kidney disease prevalence among Australian adults over time. Cat. no. CDK 6. Canberra: AIHW.