Chronic kidney disease: Australian facts

Chronic kidney disease (CKD) may be listed as the underlying cause of death – or, more commonly, as an associated cause – on a death certificate where another condition is listed as the underlying cause.

In 2020, CKD was listed as an underlying cause of death in around 4,200 cases (24% of all CKD deaths). It was recorded as an associated cause in a further 13,500 deaths (around 76% of CKD deaths). Deaths with CKD as an underlying or associated cause accounted for 11% of all deaths in Australia in 2020.

Linked data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry and National Death Index has shown that CKD, particularly kidney failure, is often an under-reported cause of death (AIHW 2016).

Diseases commonly listed as underlying causes of death where chronic kidney disease is an associated cause

In cases where CKD was an associated cause of death, the most common groups of underlying causes were:

• diseases of the circulatory system (33%)
• cancers (21%)
• endocrine, nutritional and metabolic diseases (10%)
• diseases of the respiratory system (8.0%).

More specifically, the most common underlying causes of death, by 3-digit International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) code, were:

• heart failure (11%)
• unspecified dementia (4.6%)
• acute myocardial infarction (4.5%)
• type 2 diabetes mellitus (4.4%)
• other chronic obstructive pulmonary disease (3.9%).

In about a third of cases where CKD was listed as an associated cause of death, the underlying cause was a disease of the circulatory system. This reflects the common comorbidity of CKD and cardiovascular diseases (see Comorbidity of chronic kidney disease for more information).

Epidemiological data also suggest that individuals with CKD are at increased risk of experiencing cognitive impairment and of developing dementia (Bugnicourt et al. 2013). This may explain why CKD is commonly listed as an associated cause of death in deaths due to unspecified dementia.

In cases where CKD was the underlying cause of death, the most common groups of associated causes included:

• diseases of the circulatory system (42%) – such as heart failure (10%), primary hypertension (8.3%) and chronic ischaemic heart disease (5.8%)
• endocrine, nutritional and metabolic diseases (14%) – such as type 2 and unspecified diabetes mellitus (5.6% and 4.4%, respectively)
• diseases of the respiratory system (8.1%) – such as pneumonia (1.9%) and chronic obstructive pulmonary disease (1.7%)
• diseases of the genitourinary system (7.1%) – such as acute kidney failure with tubular necrosis (5.7%).

Trends over time

The number of deaths with CKD as an underlying or associated cause rose by 75% between 2000 and 2020 (10,200 and 17,700 deaths). After accounting for changes in the age structure of the population over this time, the rate of CKD deaths remained relatively stable between 2000 and 2015 and declined slightly from 2015 to 2020.

Between 2000 and 2020:

• the death rates for males ranged between 64 and 80 deaths per 100,000 population, after adjusting for age (Figure 1)
• the death rate for females was consistently lower than for males, ranging between 42 and 48 deaths per 100,000 population, after adjusting for age (Figure 1)
• on average, CKD was the underlying or associated cause of death in around 14,500 deaths per year.

Figure 1: Trends in chronic kidney disease death rates (underlying or associated cause), by sex, 2000 to 2020  

Variation by age and sex

In 2020, death rates for CKD as an underlying or associated cause:

• were 1.5 times as high in males as in females (64 and 42 deaths per 100,000 population)
• were consistently higher in males than females across all age groups
• increased drastically with age and were much higher in the 85 and over age group. This age group accounted for 51% of all deaths due to CKD in 2020 and had an age‑specific death rate that was 4.3 times as high as for people aged 75–84 (1,700 and 391 deaths per 100,000 population) (Figure 2).

Figure 2: Chronic kidney disease death rates (underlying or associated cause), by age and sex, 2020

Variation between population groups

Aboriginal and Torres Strait Islander people

In 2018–2020, CKD contributed to around 1,700 deaths (as an underlying or associated cause) among Indigenous Australians and these deaths accounted for around 4.7% of all deaths due to CKD during this period.

Indigenous Australians were about 3.9 times more likely to die from CKD than non‑Indigenous Australians, after adjusting for age (196 and 50 per 100,00 population).

This difference was greater in females than in males. CKD death rates for Indigenous females and males were 4.7 and 3.3 times as high, respectively, compared with their non-Indigenous counterparts (Figure 3).

Note, for data by Indigenous status, rates are reported for 5 jurisdictions combined – New South Wales, Queensland, Western Australia, South Australia and the Northern Territory.

Remoteness and socioeconomic area

In 2020, the age-standardised death rate for CKD (as an underlying or associated cause of death) was higher in Remote and very remote areas and in areas with increased socioeconomic disadvantage.

• Death rates in Remote and very remote areas were almost twice as high as in Major cities (94 and 49 per 100,000 population). This difference was greater for females than males (2.4 times as high for females and 1.5 times as high for males).
• The mortality rate was higher in males than females across all remoteness areas.
• The difference between male and female death rates was greatest in Major cities (62 and 39 per 100,000 population, respectively) and lowest in Remote and very remote areas (96 and 93 per 100,000 population respectively).
• Death rates were 1.8 times as high in the lowest socioeconomic area than in the highest socioeconomic area (68 and 37 deaths per 100,000 population).
• Males had a higher death rate than females across all socioeconomic areas (Figure 3).

Figure 3: Chronic kidney disease deaths (underlying or associated cause), by population group, 2018–​2020

References

AIHW (Australian Institute of Health and Welfare) (2016) Incidence of end-stage kidney disease in Australia 1997–2013,  catalogue number PHE 211, AIHW, Australian Government, accessed 7 February 2021.

Bugnicourt JM, Godefroy O, Chillon JM, Choukroun G and Massy ZA (2013) ‘Cognitive disorders and dementia in CKD: the neglected kidney–brain axis’, Journal of the American Society of Nephrology, 24(3):353–363, doi:10.1681/ASN.2012050536.