End-stage kidney disease (ESKD) is the most severe form of chronic kidney disease (CKD), where kidney function deteriorates so much that dialysis or kidney transplantation is required to survive. This project estimates the total number of new (incident) cases of ESKD in Australia, including cases treated with dialysis or transplant and those not receiving these treatments.

The incidence of ESKD is a key indicator of the health of the Australian population, but in the past we have been limited to counting only those treated with dialysis or transplant. This report presents a new method for estimating the total incidence of ESKD.

New method for estimating the total incidence of ESKD

The number of non-KRT-treated cases is estimated using a defined set of cause of death codes in the national mortality data, with the aim of counting people who died with ESKD in the study period. This number can then be added to the already available number of dialysis and transplant cases recorded on a national register. Data linkage is used to ensure that people treated with dialysis or transplant who die during the study period are only counted once.

Key results

During the period 2003–2007, there were nearly 21,500 new cases of ESKD in Australia, amounting to about 21 cases per 100,000 people. For every new case who receives dialysis or transplant, there is about one new case that does not.

Men have higher total incidence rates than women, and Aboriginal and Torres Strait Islander people have much higher rates compared with the rest of the population. There is little variation across states and territories, the exception being the Northern Territory, which has much higher rates than the rest of the country, reflecting the higher proportion of Aboriginal and Torres Strait Islander people who live there.

Incidence rates increase with age, with a sharp increase from 70 years. The number of new cases was highest in those aged about 80 years for the whole population, but occurred much younger in Aboriginal and Torres Strait Islander people, at 50 years of age.

The proportion of all cases receiving dialysis or transplant varies greatly with age. For those aged under 65 years, close to, or more than, 90% of new cases receive these treatments. But treatment rates fall substantially in the older age groups, with only about one-tenth of those aged 80 years or over receiving dialysis or transplant. There is little variation in treatment rates by sex or Indigenous status.