Better health and ageing for all Australians

Aboriginal and Torres Strait Islander Health Performance Framework - 2010

1.09 End stage renal disease

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Why is it important?:

The kidneys can be permanently damaged by various acute illnesses (e.g. severe infections) or by progressive damage from chronic conditions such as elevated blood pressure (untreated hypertension) and long-standing high blood sugar levels (untreated diabetes). If the kidneys cease functioning entirely (known as end stage renal disease, or kidney failure), waste products and excess water build up rapidly in the body. This will cause death within a few days or weeks unless a machine is used to filter the blood several times per week (renal dialysis) or a new kidney is provided by transplant.

Aboriginal and Torres Strait Islander peoples have very high levels of end stage renal disease (ESRD) due to a range of risk factors and antecedents including low birthweight (see 1.01) (White et al. 2010). ESRD contributes substantially to the high burden of ill health experienced by Aboriginal and Torres Strait Islander people. In non-Indigenous Australians, ESRD usually occurs in older age, but for Aboriginal and Torres Strait Islander peoples, it occurs more frequently in the middle adult years. Incidence rates of particular forms of kidney disease occur almost exclusively in Indigenous children in Australia and New Zealand (White et al. 2010). Fewer Indigenous patients receive kidney transplants, so most must have dialysis 3 times a week for the rest of their lives, impacting greatly on quality of life and social and emotional wellbeing (AIHW 2005a; McDonald et al. 2006; Devitt et al. 2008).

Findings:

The incidence of patients commencing ongoing renal replacement treatment (dialysis or kidney transplantation) for ESRD is higher for Aboriginal and Torres Strait Islander peoples than non-Indigenous Australians. There is considerable variation in incidence rates between jurisdictions and between urban, rural and remote areas. Between 2006 and 2008, there were 696 new Aboriginal and Torres Strait Islander patients registered as commencing ESRD treatment, accounting for 10% of all new registrations. The age-adjusted incidence rate of treated ESRD was 8 times as high for Aboriginal and Torres Strait Islander peoples as non-Indigenous people. In contrast to non-Indigenous Australians, ESRD incidence is higher for Indigenous women than Indigenous men.

ESRD incidence was higher for Aboriginal and Torres Strait Islander peoples in all adult age groups, with the greatest relative excess across the 45–64 year age groups. Indigenous people commencing ESRD treatment are much younger than non-Indigenous Australians commencing ESRD treatment, with almost two-thirds aged under 55 years compared with one third of other Australians commencing ESRD treatment.

In the period 2006–08, ESRD incidence for Aboriginal and Torres Strait Islander peoples was much higher in outer regional and remote areas than urban areas. The relative excess in ESRD incidence was greatest in very remote and remote areas (18 to 20 times as high as for non-Indigenous Australians in the same areas), compared with outer regional (11 times as high) and major cities and inner regional areas (4 times as high). For other Australians, there is little difference in ESRD incidence between jurisdictions or between urban, rural and remote areas.

Incidence rates for Indigenous Australians were highest in the Northern Territory (188 per 100,000) and lowest in New South Wales (33 per 100,000).

The number of Aboriginal and Torres Strait Islander patients starting ESRD treatment has more than quadrupled between 1991 and 2008. ESRD incidence for other Australians has also increased, but not as rapidly. The rapid increase in the incidence of ESRD in the Aboriginal and Torres Strait Islander population may reflect both real growth in the underlying disease, an increase in availability of kidney treatment and/or improved levels of identification of Aboriginal and Torres Strait Islander people in the registry.

ESRD patients require either a kidney transplant or dialysis to maintain the functions normally performed by the kidneys. In December 2008, there were 1,306 Indigenous Australians registered for ESRD. Of these, 88% were reliant on dialysis and only 12% had received a kidney transplant. In comparison, 55% of non-Indigenous Australians living with ESRD were reliant on dialysis and 45% had a functioning kidney transplant. Indigenous Australians with ESRD were 10 times as likely as non-Indigenous Australians with ESRD to be reliant on dialysis.

Implications:

The very high level of ESRD in Aboriginal and Torres Strait Islander peoples is associated with the high rates of diabetes, high blood pressure and related diseases, and possibly the high rates of bacterial infections and glomerulonephritis in childhood (AIHW 2005a). These in turn are associated with barriers to accessing primary care and environ-mental determinants. Healthier nutrition and greater physical activity play a role, as well as early diagnosis and treatment of conditions associated with renal failure.

In response to increasing demand some jurisdictions and communities have enhanced home or community-based dialysis services. In the Northern Territory a Mobile Dialysis Bus service offers respite dialysis to communities on a frequent basis. This is particularly important for remote communities, where people with ESRD often need to travel long distances, or else permanently relocate, in order to recieve dialysis. Indigenous Australians have relatively poorer access to kidney transplants and addressing barriers is important (Cass et al. 2003; Yeates et al. 2009).

A focus on improving primary prevention, detection and management is necessary to lessen the impact of ESRD on people with the condition and in terms of the cost to the health care system and to Aboriginal and Torres Strait Islander peoples. The National Partnership on Closing the Gap in Indigenous Health Outcomes (COAG 2008c) sets a number of priorities aimed at chronic disease prevention, detection and management.

Figure 23 – Age-standardised registration rates for end stage renal disease, by Indigenous status, 1991 to 2008


Figure 23 – Age-standardised registration rates for end stage renal disease, by Indigenous status, 1991 to 2008
Source: AIHW analysis Australian and New Zealand Dialysis and Transplant Registry (ANZDATA)
Text description of figure 23 (TXT 1KB)

Figure 24 – Incidence of end stage renal disease by Indigenous status and age group, 2006–2008


Figure 24 – Incidence of end stage renal disease by Indigenous status and age group, 2006–2008
Source: AIHW analysis of Australian and New Zealand Dialysis and Transplant Registry (ANZDATA)
Text description of figure 24 (TXT 1KB)

Figure 25 – Age-standardised incidence of end stage renal disease by Indigenous status and remoteness, 2006–2008


Figure 25 – Age-standardised incidence of end stage renal disease by Indigenous status and remoteness, 2006–2008
Source: AIHW analysis of Australian and New Zealand Dialysis and Transplant Registry (ANZDATA)
Text description of figure 25 (TXT 1KB)

Table 16 – Total patients with end stage renal disease, by Indigenous status and treatment, 31 December 2008

Treatment:
Number
Rate per 100,000 (age adjusted)
Ratio
Indig.
Non-Indig.
Indig.
Non-Indig.
Dialysis
1,147
8,915
390
40
9.8*
Transplant
159
7,382
46
34
1.3*
Total
1,306
16,297
436
74
5.9*
Represents results with statistically significant differences in the Indigenous/non-Indigenous comparisons at the p<.05 level.

Source: AIHW analysis of Australian and New Zealand Dialysis and Transplant Registry (ANZDATA)

Table 17 – Incidence of end stage renal disease in Aboriginal and Torres Strait Islander people, by jurisdiction, 2006–2008

Male
Female
Persons
No.
Rate (a)
Ratio
No.
Rate (a)
Ratio
No.
Rate (a)
Ratio
New South Wales
39
35
2.7*
41
31
4.1*
80
33
3.2*
Victoria
12
62
4.6*
11
43
6.7*
23
51
5.2*
Queensland
90
81
6.3*
94
83
10.3*
184
82
8.0*
Western Australia
66
108
8.1*
80
128
20.0*
146
119
12.2*
South Australia
18
81
6.5*
25
93
14.5*
43
87
9.5*
Tasmania
n.p.
n.p.
n.p.
n.p.
n.p.
n.p.
n.p.
n.p.
n.p.
Australian Capital Territory
n.p.
n.p.
n.p.
n.p.
n.p.
n.p.
6
131
7.1*
Northern Territory
88
169
18.1*
125
205
42.7*
213
188
25.7*
Australia
318
78
5.9*
378
83
11.5*
696
80
8.0*
n.p. refers to ‘not published’ as the rate is based on very small numbers.
* Represents results with statistically significant differences in the Indigenous/other comparisons at the p<.05 level.

Source: AIHW analysis of Australian and New Zealand Dialysis and Transplant Registry (ANZDATA)

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