Latest information and statistics on Kidney health

Kidneys clean the blood by processing excess fluid, unwanted chemicals and waste, and producing urine [41199]. If the kidneys stop working properly, waste can build up in the body and lead to kidney disease (sometimes called renal disease) [28715][39742].

The most common cause of kidney disease is diabetes and there is a strong link between kidney disease and high blood pressure [42280]. Other causes include immune diseases, congenital conditions and genetic disorders, such as polycystic kidney disease. Many people are unaware that they have kidney disease as up to 90% of kidney function can be lost before symptoms appear [45156].

Chronic kidney disease (CKD) refers to conditions of the kidney that cause dysfunction or kidney damage and last for three months or more [45756]. There are five stages of CKD according to the level of kidney function. In early stages (1-2), there are usually no symptoms, and the kidneys are still able to function when they are slightly damaged, making diagnosis difficult. In middle stages (3-4), levels of waste (urea and creatinine) in the blood rise and the person starts to feel unwell and kidney function slows down with increased urination. In end-stage kidney disease (ESKD)[1](stage 5), a person will require dialysis or a transplant to stay alive.

CKD can be prevented by a healthy lifestyle or treatment, if detected early [42065]. Modifiable risk factors include high blood pressure, tobacco smoking, overweight and obesity and impaired glucose regulation [45156]. For Aboriginal and Torres Strait Islander people, non-modifiable risk factors associated with CKD also include being over the age of 30 years, family history of CKD, history of acute kidney injury and established vascular disease [34668].

Extent of kidney disease among Aboriginal and Torres Strait Islander people

Prevalence and incidence

Approximately 1.8% of Aboriginal and Torres Strait Islander people (Aboriginal people: 1.9% and Torres Strait Islander people: 0.4%) reported kidney disease as a long-term health condition in the 2018-19 NATSIHS [39231]. The proportion of Aboriginal and Torres Strait Islander people reporting kidney disease was higher for females (2.3%) than males (1.2%). The reported prevalence of kidney disease among Aboriginal and Torres Strait Islander people was less than 2% for all age-groups under 35 years, increasing to 2.3% for people aged 35-44 years, 2.7% for people aged 45-54 years and 7.6% for people aged 55 years and over. By jurisdiction, the highest proportions were reported for the NT (3.7%) and WA (2.9%), with the other states and territories (excluding Tas) less than 2% each. Proportions were higher for people living in remote areas (3.4%) than non-remote areas (1.4%).

With most information on CKD limited to self-reported data, the primary focus in the literature has been on end-stage renal disease (ESRD). Data from the ANZDATA for the five-year period 2018-2022 reveals that the age-standardised notification rate of ESRD for Aboriginal and Torres Strait Islander people was 605 per 1,000,000 population (Derived from [48007][37834]). The highest notification rates of ESRD were recorded for Aboriginal and Torres Strait Islander people living in the NT (1,781 per 1,000,000), WA (1,071 per 1,000,000), and SA (709 per 1,000,000) (Table 1).

Table 1. Numbers of notifications and age-standardised notification rates for ESRD for Aboriginal and Torres Strait Islander people, selected jurisdictions, Australia, 2018-2022

Jurisdiction	Aboriginal and Torres Strait Islander
	Number	Rate
NSW	173	153
Vic	55	277
Qld	492	637
WA	401	1,071
SA	111	709
NT	533	1,781
Australia	1,788	605

Notes:

• Rates per 1,000,000 population have been standardised using the ERP from 30 June 2001.
• Notification rates for Tas and the ACT have not been shown separately because of the small numbers of notifications but are included in the figures for Australia.

Source: Derived from ANZDATA, 2023 [48007], ABS, 2019 [37834]

Of people newly registered with the ANZDATA in 2018-2022, 54% of Aboriginal and Torres Strait Islander people were aged less than 55 years (Table 2) (Derived from [48007]).

Table 2. Numbers of notifications and notification rates of ESRD for Aboriginal and Torres Strait Islander people by age-group, Australia, 2018-2022

Age-group (years)	Aboriginal and Torres Strait Islander
	Number	Crude rate
0-14	16	11
15-24	36	44
25-34	139	211
35-44	249	550
45-54	521	1,220
55-64	509	1,638
65-74	271	1,695
75+	47	779
All ages (crude)	1,788	415
All ages (age-standardised)	1,788	605

Note: Rates per 1,000,000 population.

Source: Derived from ANZDATA, 2023 [47770], ABS, 2019 [37834]

Hospitalisation, dialysis and transplantation

Detailed information from ANZDATA is available for 2023, when a total of 361 Aboriginal and Torres Strait Islander people commenced haemodialysis (HD) and peritoneal dialysis (PD) (HD: 318 and PD: 43), a decrease from 2022 (375 people) [49751]. The NT accounted for the highest proportion of patients commencing dialysis (30%), followed by Qld (25%) and WA (19%).

In 2023, there were 2,185 prevalent dialysis patients in Australia (PD and HD treatments), who identified as an Aboriginal and/or Torres Strait Islander person [49751]. HD accounted for the majority of treatment (94%), with only 5.7% of Aboriginal and Torres Strait Islander dialysis patients receiving PD (Derived from [49751]). The highest proportion of patients on dialysis were from the NT (32%), followed by Qld (25%) and WA (23%) [49751]. By modality, the NT had the highest proportion of patients on HD (33%) and Qld on PD (37%).

In 2021-22, the crude hospitalisation rate was 34 per 1,000 (27 per 1,000 for males and 41 per 1,000 for females) for Aboriginal and Torres Strait Islander people with CKD as a principal or additional diagnosis [45756]. For regular dialysis as a principal diagnosis, the rate was 299 per 1,000 hospitalisations (256 per 1,000 for males and 342 per 1,000 for females).

In 2018-19 there were 242,274 hospitalisations for Aboriginal and Torres Strait Islander people for ESKD (crude rate 289 per 1,000) [42032]. Detailed information for ESKD is available for 2016-18. The crude hospitalisation rate for ESKD among Aboriginal and Torres Strait Islander people was 278 per 1,000 (males: 241 per 1,000, females: 316 per 1,000). Rates increased with remoteness: 137 per 1,000 for major cities, 229 per 1,000 for inner and outer regional areas and 681 per 1,000 for remote and very remote areas. The rate for remote and very remote areas was 5.0 times the rate for major cities.

At the start of 2022, 77 (5.7%) of the 1,354 patients on the waiting list for a kidney transplant were of Aboriginal and/or Torres Strait Islander origin [47770]. In the same year, there were 55 kidney transplant operations for Aboriginal and Torres Strait Islander recipients, which comprised 5.9% of all transplant operations in Australia.

Mortality

In 2020-22 there were 2,299 deaths[2] from CKD (as an underlying or associated cause of death) among Aboriginal and Torres Strait Islander people (crude rate 93 per 100,000)[45756]. There were 1,033 deaths among males and 1,266 deaths among females, with crude rates of 83 per 100,000 and 103 per 100,000 respectively. In 2018-22, the age-standardised mortality rate for kidney disease (as a major cause of death) among Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT was 24 per 100,000 [48392]. When comparing jurisdictions, the mortality rate was highest in the NT (54 per 100,000), followed by WA and SA (both 26 per 100, 000), Qld (19 per 100,000) and NSW (18 per 100, 000).

In 2022, diseases of the urinary system were reported as an underlying cause of 108 deaths (males: 44; females: 64) among Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA and the NT [47832]. The age-standardised death rate for diseases of the urinary system among Aboriginal and Torres Strait Islander people was 34 per 100,000 (males: 28 per 100,000, females: 39 per 100,000).

In 2023, 308 Aboriginal and Torres Strait Islander people who were receiving dialysis died [49751]. The most common causes of death for the dialysis patients were CVD (101 deaths: 33%), withdrawal from treatment (69 deaths: 22%) and infection (39 deaths: 13%). Most deaths were among Aboriginal and Torres Strait Islander people on HD treatment (94%).

Burden of disease

In 2018, diseases of the kidney and urinary system[3] were the 12^th leading cause of disease burden for Aboriginal and Torres Strait Islander people. For specific diseases, CKD was the 10^th leading cause of disease burden, contributing to 2.5% of the total burden [43959]. For females, CKD was the 8^th leading cause of total disease burden (3.1% of total burden), and for males it was the 15^th leading cause of total disease burden (2.0% of total burden). Across age groups, CKD was the fourth leading cause of total disease burden for those aged 65-74 years (6.0% of proportion of total burden); fifth for those aged 45-64 years (4.0% of total burden); and sixth for those aged 75 years and over (4.7% of total burden).

[1] Used interchangeably with end-stage renal disease (ESRD).

[2] Number of deaths include all states and territories of Australia. Crude rates are expressed as deaths per 100,000 population, for NSW, Qld, WA, SA and the NT.

[3] Kidney and urinary conditions comprise CKD (stages 1-5), kidney stones, interstitial nephritis, enlarged prostate, and other kidney and urinary diseases [46214].