An epidemic of renal failure among Australian Aboriginals

Abstract

ObjectiveTo define recent trends (1993‐1996) in incidence of endstage renal disease (ESRD) among Australian Aboriginal people in the Top End of the Northern Territory (NT). DesignAnalysis of hospital and clinical records of the Darwin‐based ESRD treatment program from 1993 to 1996 and comparison with data accumulated since 1978. ParticipantsAll people entering the ESRD treatment program from 1978 to 1996. Main outcome measuresNumber of patients treated for ESRD; their ethnicity, age and sex; comorbidities in Aboriginal patients; treatment methods and outcomes. ResultsMore Aboriginal people presented with ESRD between 1993 and 1996 (87) than in the previous 15 years of the program (68). The incidence of ESRD in Aboriginals reached 838 per million in 1996, and is doubling every 4 years. Aboriginal people presenting with ESRD are younger than non‐Aboriginal people with ESRD, and, in contrast to non‐Aboriginals, ESRD rates are higher in women than men. The numbers and proportions of Aboriginal ESRD patients who have hypertension, type 2 diabetes and cardiac disease are rising. Haemodialysis remains the most common form of treatment, and the number of dialysis treatments is doubling every 2.5 years. Only 9% of Aboriginal patients entering the program in 1993‐1996 were treated with chronic ambulatory peritoneal dialysis and only 3% received transplants. Despite their younger age, survival of Aboriginal people on dialysis is low (median 3.3 years v. 6.5 years in non‐Aboriginals), and graft survival after transplant is poor (37% at 5 years v. 88% in non‐Aboriginals). Survival has not improved in the past 4 years, with fewer deaths from infection offset by more deaths from cardiovascular disease. Better living conditions and education, robust and integrated primary healthcare programs, and systematic screening for early renal disease and treatment of those with established disease are all matters of urgency. ConclusionsThe predicted doubling of ESRD incidence among Aboriginal people by the year 2000 will add an enormous burden to limited resources. Risk factors for renal disease underlie all the excess morbidity and mortality in NT Aboriginal adults, and arise out of accelerated lifestyle changes and socioeconomic disadvantage.

Type 2 diabetes in Indigenous populations: Quality of intervention research over 20years

“…In the United States, the age-adjusted death rate for diabetes mellitus in American Indians/Alaskan Natives in 2006 was 1.9 times higher than in US non-Hispanic whites (39.6 and 20.4 per 100,000, respectively) (US Department of Health and Human Services, 2006). The severity of certain diabetic complications including endstage renal disease and lower-extremity amputation tends to be significantly higher among Indigenous groups (Chaturvedi et al, 2001;Naqshbandi et al, 2008;Spencer et al, 1998). Addressing Type 2 diabetes and the background risk factors (including obesity, sedentary behavior, and gestational diabetes) is critical to reducing Indigenous health inequalities in these countries.…”

C-reactive protein, cardiovascular risk, and renal disease in a remote Australian Aboriginal community

“…Rates of end-stage renal disease are also extremely high, particularly among those living in the Northern Territory and other remote areas [2]. In one Aboriginal community, albuminuria has been shown to be predictive of subsequent end-stage renal disease [3] and death [4].…”

Post-streptococcal glomerulonephritis is a strong risk factor for chronic kidney disease in later life

“…In these communities, chronic renal disease and end-stage renal failure also occur in adults at alarming rates. 6,7 PSGN is usually followed by clinical recovery over several days to weeks, and the long-term outlook has generally been regarded as excellent, with no increase in risk of urinary abnormalities or hypertension. [8][9][10] However, some studies have suggested that there is an increase in chronic renal impairment after this illness.…”