This report presents a demographic and health profile of Aboriginal and Torres Strait Islander Australians with kidney disease. The aim of this report is inform future policy development and service planning relating to kidney health among Indigenous people.
Chronic kidney disease (CKD) is defined as the presence of impaired or reduced kidney function lasting at least 3 months. A person who has the most severe form of CKD, end-stage kidney disease (ESKD), usually requires a kidney transplant or dialysis to survive. CKD is highly under-diagnosed, as it is often asymptomatic in the less severe stages.
In 2012–13, 18% (59,600) of Indigenous adults aged 18 and over had biomedical signs of CKD, but only around 1 in 10 (11%) of these self-reported having kidney disease. The rate of CKD increased with age, affecting approximately half (49%) of Indigenous adults aged 65 and over. After accounting for differences in age structure, Indigenous Australian adults were twice as likely as non-Indigenous adults to have biomedical signs of CKD (22% and 10%, respectively).
Characteristics of Indigenous Australians with CKD
Indigenous adults with CKD were significantly less likely than those without to have completed Year 12, be currently employed, or have a healthy waist circumference. After adjusting for differences in age, Indigenous Australians with CKD were also more likely to experience selected comorbidities than those without, including diabetes (36% compared with 12%), cardiovascular disease (35% compared with 24%) and high cholesterol levels (7% compared with 3.6%).
Results from multivariate regression modelling showed that the likelihood of having CKD increased consistently with age, decreased consistently with increasing household income, was similar for men and women, was higher in remote areas compared with non-remote areas, and was higher among individuals with high blood pressure or diabetes (2.0 and 2.9 times as likely, respectively).
Hospitalisations related to CKD
During the 2-year period from July 2015 to June 2017, there were almost 6,000 hospital separations of Indigenous Australians where kidney disease was the principal diagnosis, and a further 461,000 separations where kidney dialysis was the principal diagnosis. Separation rates were considerably higher among Indigenous Australians than among non-Indigenous Australians. The areas of Tennant Creek and Apatula in the Northern Territory had the highest separation rates for both dialysis and other kidney diseases.
End-stage kidney disease patients
At 31 December 2017, approximately 8.8% (2,160) of people receiving treatment for ESKD in Australia were Indigenous Australians. The treatment rate among Indigenous Australians was 5 times that among non-Indigenous Australians, and was highest in Remote areas.
The number of Indigenous Australians beginning ESKD treatment has increased over time, from 240 in 2007 to 352 in 2017. Over the 3-year period 2015 to 2017, Indigenous Australians aged 45–54 and 55–64 were the most likely to begin ESKD treatment (31% and 26% of all new Indigenous patients, respectively).