An expanded nationwide view of chronic kidney disease in Aboriginal Australians

Abstract

We summarize new knowledge that has accrued in recent years on chronic kidney disease (CKD) in Indigenous Australians. CKD refers to all stages of preterminal kidney disease, including end‐stage kidney failure (ESKF), whether or not a person receives renal replacement therapy (RRT). Recently recorded rates of ESKF, RRT, non‐dialysis CKD hospitalizations and CKD attributed deaths were, respectively, more than sixfold, eightfold, eightfold and threefold those of non‐Indigenous Australians, with age adjustment, although all except the RRT rates are still under‐enumerated. However, the nationwide average Indigenous incidence rate of RRT appears to have stabilized. The median age of Indigenous people with ESKF was about 30 years less than for non‐Indigenous people, and 84% of them received RTT, while only half of non‐Indigenous people with ESKF did so. The first‐ever (2012) nationwide health survey data showed elevated levels of CKD markers in Indigenous people at the community level. For all CKD parameters, rates among Indigenous people themselves were strikingly correlated with increasing remoteness of residence and socio‐economic disadvantage, and there was a female predominance in remote areas. The burden of renal disease in Australian Indigenous people is seriously understated by Global Burden of Disease Mortality methodology, because it employs underlying cause of death only, and because deaths of people on RRT are frequently attributed to non‐renal causes.These data give a much expanded view of CKD in Aboriginal people. Methodologic approaches must be remedied for a full appreciation of the burden, costs and outcomes of the disease, to direct appropriate policy development.

Access to waitlisting for deceased donor kidney transplantation in Australia

“…Australia's Indigenous population experiences a disproportionally high burden of chronic disease compared to non‐indigenous Australians, including kidney disease, with rates of RRT eightfold higher in the Indigenous population . Reduced access to transplant waitlisting and transplantation for Indigenous people has previously been reported and post‐transplant outcomes are poorer for Indigenous recipients .…”

Female preterm indigenous Australian infants have lower renal volumes than males: A predisposing factor for end‐stage renal disease?

“…While Indigenous status is an important determinant of CKD in the Australian population, gender is an important determinant of the need for renal dialysis . In remote Australia, the incidence of Indigenous women needing dialysis is higher compared with Indigenous men . A retrospective cohort analysis, Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry from 2001 to 2013 ( n = 21 832) reported that the incidence of dialysis in Indigenous women was higher than in Indigenous men (513 per million population and 406 per million population, respectively) .…”

“…The reverse was reported among non‐Indigenous people. Death associated with renal diseases between 1998 and 2012 was 3.9 times higher in Indigenous females and 2.6 times higher for Indigenous males when to compared with non‐Indigenous Australians . The causes of these disparities need to be fully understood.…”

Acute kidney injury in Indigenous Australians in the Kimberley: age distribution and associated diagnoses

“…About 1.7 million Australians have CKD, and the total costs attributable to CKD in 2012 were estimated to be $4.1 billion, including $2.5 billion in direct health care costs . The greater burden of CKD among Australian Aboriginals and Torres Strait Islanders (Indigenous Australians) than among other Australians is well documented; the incidence of end‐stage kidney disease is 4.9 times as high among Indigenous men and 8.0 times as high among Indigenous women as among non‐Indigenous Australians, and the incidence of CKD increases with remoteness . Further, the mean age of Indigenous patients commencing renal replacement therapy (RRT) is lower .…”