Skip to content
Tier 1 - Health status and outcomes

1.10 Kidney disease

Key facts

Why is it important?

Kidneys are crucial to overall health, playing a vital role in cleaning the blood, removing waste and extra fluid from the body, managing Vitamin D production and regulating blood pressure (Kidney Health Australia). The kidneys can be permanently damaged by various acute illnesses or by progressive damage from uncontrolled elevated blood pressure and longstanding high blood sugar levels (untreated or poorly managed diabetes).

Chronic kidney disease refers to conditions of the kidney, lasting three months or longer, affecting the filtration and removal of waste from the blood by the kidneys. Chronic kidney disease progresses in five stages of increasing severity. Up to 90% of kidney function may be lost before any symptoms of chronic kidney disease are present, sometimes not until Stage 5. Due to the asymptomatic nature of chronic kidney disease and low awareness among Australians of the risk factors, the condition remains under-recognised in Australia (Kidney Health Australia 2020).

If the kidneys cease functioning entirely (known as end-stage kidney disease, or kidney failure), waste products and excess water build up rapidly in the body. This can cause death within a few days or weeks unless a machine is used to filter the blood several times per week (kidney dialysis), or a new kidney is provided by transplant. Aboriginal and Torres Strait Islander people are less likely to receive kidney transplants than non-Indigenous Australians, so many require dialysis three times a week for the rest of their lives, impacting quality of life and social and emotional wellbeing for patients and their carers (Chadban et al. 2005; Devitt et al. 2008; Khanal et al. 2018; Rix et al. 2015).

Kidney disease can also contribute to, or be impacted by, chronic diseases including cardiovascular disease and diabetes (AIHW 2016a). These three diseases account for around one quarter of the disease burden in Australia and share a number of common risk factors such as tobacco smoking, overweight and obesity, and high blood pressure. Indigenous Australians have higher levels of risk factors associated with chronic diseases and are at a greater risk of developing chronic kidney disease, particularly those in remote areas. In many cases chronic kidney disease is preventable, as several key risk factors are modifiable (AIHW 2011).

The Chronic Kidney Disease Management in Primary Care (4th edition) recommends individuals with risk factors for chronic kidney disease to undergo a kidney health check every one to two years. This includes all Indigenous Australians 30 years or older, and those aged 18 to 29 years with one or more risk factors. Ideally, the kidney health check should use three tests: a blood test for kidney functioning (the estimated glomerular filtration rate - eGFR), a urine test to check for albumin (a protein that can pass into the urine when kidneys are damaged) and a blood pressure check (Kidney Health Australia 2020). Through early detection and appropriate management, deterioration in kidney function can be reduced by up to 50% and possibly even reversed (Johnson 2004). 

Kidney disease is considerably more likely to be recorded as an additional diagnosis than as the principal diagnosis in hospital separations. In 2013­–14, of almost 20,000 separations for Indigenous Australians where chronic kidney disease was recorded (excluding separations for dialysis), it was listed as the principal diagnosis in only one in seven cases (AIHW 2015). Similarly, kidney disease is much more likely to be recorded on death certificates as an associated cause of death rather than as the underlying cause (AIHW 2015). There is also evidence that it may be under-reported as a cause of death, with a study using linked data from Western Australia and New South Wales showing that substantial proportions of people hospitalised with or receiving treatment for end-stage kidney disease do not have end-stage kidney disease recorded on their death certificate (AIHW 2014a; Sypek MP 2018). Looking only at the principal diagnosis or underlying cause of death therefore under-represents the true impact of chronic kidney disease.

This measure includes some high-level data about kidney disease as an additional diagnosis or an associated cause of death, and this will be further explored in future editions of this report.  

Burden of disease

Chronic kidney disease accounted for 1.9% of the burden of disease for Indigenous Australians in 2011. Indigenous Australians experienced 7.3 times the burden of disease from chronic kidney disease compared with non-Indigenous Australians. High body mass contributed 46% of the chronic kidney disease burden for Indigenous Australians and high blood pressure contributed 24%.

The total burden of chronic kidney disease may be underestimated as the Burden of Disease method for estimating fatal burden is based on the underlying cause of death only and does not capture the contribution of chronic kidney disease as an associated cause of death (for example, where multiple causes contribute to death) (AIHW 2016b). Further, kidney disease is a risk factor for other diseases including coronary heart disease, stroke and dementia, and this indirect burden is also not accounted for using the standard methods. An analysis of the indirect burden of chronic kidney disease , through quantifying its impact on other diseases, suggested that the collective burden of chronic kidney disease in Australia is more than double (2.1 times) the direct burden (AIHW 2016b). Data on the indirect burden of chronic kidney disease in Indigenous Australians is not currently available, but is likely to be considerable given the high prevalence of kidney disease, diabetes and cardiovascular disease in this population.

Findings

What does the data tell us?

Death rates for kidney diseases

In the period 2014–2018, 1.8% (259) deaths of Indigenous Australian were due to kidney disease. After adjusting for differences in the age structure between the two populations, this was 2.2 times the rate of non-Indigenous Australians (18.6 compared with 8.3 per 100,000) (Table D1.10.4). There were also an additional 2,709 deaths among Indigenous Australians where kidney disease was listed as an associated cause of death (Table D1.23.24). Kidney diseases was 2.8 times as likely to be listed as an associated cause of death for Indigenous Australians compared with non-Indigenous Australians (182 compared with 64 per 100,000 population). These data are for the five jurisdictions with Indigenous identification data of adequate quality (New South Wales, Queensland, Western Australia, South Australia and the Northern Territory). 

Death rates for kidney disease as the underlying cause of death declined significantly among both Indigenous Australians (61%) between 1998 and 2018 (Table D1.23.23, Figure 1.10.1). However, when deaths with kidney diseases as either the underlying or an associated cause are considered, the rate for Indigenous Australians has increased over this period (from 174 to 201 per 100,000), while the rate for non-Indigenous Australians has remained stable at around 70 per 100,000.

Figure 1.10.1:  Mortality rates for kidney diseases (age-standardised), by Indigenous status, NSW, Qld, WA, SA and NT, 1998–2018

This line chart shows that for Indigenous Australians, the mortality rate for kidney diseases fluctuated over the period, from 49 per 100,000 in 1998 to 20 per 100,000, peaking at a high of 56 per 100,000 in 2000 and dropping to a low of 15 per 100,000 in 2017. For non-Indigenous Australians, the mortality rate caused by diabetes decreased from 11 to 8 per 100,000.

Source: Table D1.23.23. AIHW and ABS analysis of the ABS Causes of Death Collection.

Hospitalisation for chronic kidney disease

Between July 2015 and June 2017, there were 460,944 hospitalisations for Indigenous Australians for care involving dialysis. This was the leading cause of hospitalisation (46%) for Indigenous Australians, and was 11 times the rate of non-Indigenous Australians (471 and 43 per 1,000, respectively).

Excluding dialysis, there were 5,998 hospitalisations for Indigenous Australians due to chronic kidney disease. This was 3 times the rate of non-Indigenous Australians (5.1 and 1.6 per 1,000, respectively) (Table D1.10.5).

There were six jurisdictions with Indigenous identification data of an adequate quality to report long-term trends (New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory). In these jurisdictions, from 2004–05 to 2016–17, the hospitalisation rate for chronic kidney disease (excluding dialysis) for Indigenous males decreased from 4.7 in 2004–05 to 4.0 per 1,000 in 2016–17. For Indigenous females there was an increase over this period, from 5.8 to 6.3 per 1,000 (Table D1.10.20, Figure 1.10.2).

Figure 1.10.2: Hospitalisation rates for a principal diagnosis of chronic kidney disease (excluding dialysis) for Indigenous Australians (age-standardised), by sex, NSW, Vic, Qld, WA, SA and NT, 2004–05 to 2016–17

This line chart shows that hospitalisation rates for chronic kidney diseases were higher for Indigenous females than for Indigenous males. The rate for Indigenous males was 4.7 per 1,000 in 2004-05 and 4.0 in 2016-17, and ranged from a low of 3.5 per 1,000 in 2010-11 to a high of 6.5 per 1,000 in 2006-07. The rate for Indigenous females was 5.8 in 2004-05 and 6.3 in 2016-17, and ranged from 5.7 per 1,000 in 2011-12 to 7.4 per 1,000 in 2014-15.

Source: Table D1.10.20. AIHW analysis of National Hospital Morbidity Database.

Between July 2015 and June 2017, the hospitalisation rate for chronic kidney disease (excluding dialysis) was highest for Indigenous Australians aged 55–64 (13 per 1,000). For non-Indigenous Australians, rates were highest for those aged 65 and over (4.1 per 1,000) (Table D1.10.6). Rates were higher for Indigenous females (6.4 per 1,000) than for Indigenous males (3.8 per 1,000) (Table D1.10.5)

For Indigenous Australians, the hospitalisation rate for chronic kidney disease (excluding dialysis) was lowest in Tasmania (1.1 per 1,000), and highest in the Northern Territory (9.6 per 1,000). The rate was lowest in Inner regional areas and highest in Very remote areas (3.2 and 10 per 1,000) (Table D1.10.7, Table D1.10.8).

When chronic kidney disease (excluding dialysis) is considered as either the principal or an additional diagnosis, the hospitalisation rate for Indigenous Australians in 2017–18 was 4.9 times that of non-Indigenous Australians, with the difference being greater for females than for males (rate ratios of 6.6 and 3.6, respectively) (AIHW 2020).

Treated end-stage kidney disease

The incidence of patients commencing ongoing kidney replacement therapy (dialysis or kidney transplantation) for end-stage kidney disease is higher for Indigenous Australians than for non-Indigenous Australians. After adjusting for differences in the age structure between the two populations, in the period 2015–2017 there were 64 new cases of treated end-stage kidney disease for every 100,000 Indigenous Australians. This was 6.9 times the rate for non-Indigenous Australians (9.2 per 100,000) (Table D1.10.10).

Between 2001 and 2017, after adjusting for differences in the age structure between the two populations, there was no significant change in the incidence of treated end-stage kidney disease for either Indigenous or non-Indigenous Australians and no significant change in the difference between the two groups (Table D1.10.13, Figure 1.10.3). Over this period, crude rates for Indigenous Australians increased significantly for New South Wales (by 70%) and Western Australia (by 66%) (Table D1.10.15).

Figure 1.10.3: Incidence rates for treated end-stage kidney disease (age-standardised), by Indigenous status and sex, 2001–2017

This line chart shows that rates for treated end-stage kidney disease for Indigenous Australians were higher than for non-Inidgenous Australians. Rates for females were higher in the Indigenous population but not the non-Indigenous population. For Indigenous males, the rate was 50 per 100,000 in 2001 and 64 per 100,000 in 2017 and for Indigenous females the rate was 82 per 100,000 in 2001 and 70 per 100,000 in 2017. For non-Indigenous males, the rates were steady and were 12 per 100,000 in both 2001 and 2017 and for non-Indigenous females the rate was 7 per 100,000 in both 2001 and 2017.

Source: Table D1.10.13. AIHW analysis of ANZDATA data.

Treated end-stage kidney disease incidence was highest for Indigenous Australians aged 55–64 (158 per 100,000). For non-Indigenous Australians, the rate was highest for those aged 65 and over (32 per 100,000) (Table D1.10.10, Figure 1.10.4).

Figure 1.10.4: Incidence of treated end-stage kidney disease, by Indigenous status and age group, 2015–2017

This bar chart shows that for both Indigenous and non-Indigenous Australians, rates of treated end-stage kidney disease increased with age, however, rates were higher for Indigenous Australians in all age groups over age 15. For Indigenous Australians aged 0 to 14 the rate was 0.7 per 100,000 and rates increased with age to a high of 158 per 100,000 in the age group 55 to 64. For non-Indigenous Australians, rates were 0.7 per 100,000 for those aged 0 to 14 and increased to a high of 32 per 100,000 for those aged 65 and over.

Source: Table D1.10.10. AIHW analysis of ANZDATA data.

The incidence rate of end-stage kidney disease for Indigenous Australians was higher for females than for males (68 and 58 per 100,000, respectively). However, for non-Indigenous Australians, rates were higher for males than for females (12 and 6 per 100,000, respectively) (Table D1.10.11, Table 1.10-1).

Table 1.10-1: Incidence of treated end-stage kidney disease, Indigenous Australians, by sex and jurisdiction, 2015–2017

Jurisdiction

Male Number

Male Number /100,000

Male Rate ratio(a)

Female Number

Female Number /100,000

Female Rate ratio(a)

All Persons Number

All Persons Number /100,000

All Persons Rate ratio(a)

NSW/ACT

73

30.1

2.4*

55

20.9

3.4*

128

25.3

2.7*

Vic

 n.p

n.p.

n.p.

 n.p

n.p.

n.p.

25

23.8

2.4*

Qld

116

62.9

5.6*

122

61.7

10.5*

238

62.4

7.3*

WA

106

115.6

9.7*

125

125.1

20.1*

231

121.0

13.4*

SA

17

56.1

4.6*

33

84.7

13.4*

50

71.1

7.8*

Tas

n.p.

n.p.

n.p.

n.p.

n.p.

n.p.

n.p.

n.p.

n.p.

NT

95

127.8

10.9*

180

233.0

25.3*

275

185.3

17.5*

Australia

420

58.2

4.7*

530

68.3

10.9*

950

63.6

6.9*

* Represents results with statistically significant differences at the p < 0.05 level in the Indigenous/non-Indigenous Australian comparisons. 

(a) Rate ratio is the age-standardised rate for Indigenous Australians divided by the age-standardised rate for non-Indigenous Australians.

Note: n.p. is 'not published' as the rate is based on very small numbers

Source: Table D1.10.11. AIHW analysis of ANZDATA data.                                                 

The incidence rate of treated end-stage kidney disease for Indigenous Australians was lowest in Inner regional areas and highest in Very remote areas (20 and 164 per 100,000, respectively) (Table D1.10.12, Figure 1.10.5).

Figure 1.10.5: Incidence rates of treated end-stage kidney disease, by Indigenous status and remoteness, 2015–2017

This bar chart shows that incidence rates of end-stage kidney disease were higher for Indigenous Australians than non-Indigenous Australians in all remoteness categories. For Indigenous Australians the rate was particularly high in Very Remote areas at 164 per 100,000 and lowest in Inner regional areas at 20 per 100,000. For non-Indigenous Australians, the rate was highest in Major cities (10 per 100,000) and lowest in Inner regional areas at 7.8 per 100,000.

Source: Table D1.10.12. AIHW analysis of ANZDATA data.

In 2015–2017, the most common primary renal disease of new patients was diabetic nephropathy (45 per 100,000). The rate for diabetic nephropathy for Indigenous Australians was 15 times the rate of non-Indigenous Australians (3 per 100,000 population) (Table D1.10.18, Figure 1.10.6).

Figure 1.10.6: Primary renal disease of new patients, by Indigenous status, 2015–2017

This bar chart shows that the most common type of primary renal disease of new patients was diabetic nephropathy (45 per 100,000 for Indigenous and 3 per 100,000 for non-Indigenous), followed by glomerulonephritis (5.3 per 100,000 for Indigenous and 1.8 per 100,000 for non-Indigenous) and hypertension (4.6 per 100,000 for Indigenous and 1.3 for non-Indigenous).

Source: Table D1.10.18. AIHW analysis of ANZDATA data.

End-stage kidney disease patients require either a kidney transplant or dialysis to maintain the functions normally performed by the kidneys. As at December 2017, there were 2,156 Indigenous Australians and 21,915 non-Indigenous Australians receiving ongoing kidney replacement therapy. For Indigenous Australians, 87% were reliant on dialysis, compared with 49% of non‑Indigenous Australians, and 13% had received a kidney transplant compared with 51% of non‑Indigenous Australians (Table D1.10.14, Table D1.10-2).

Table 1.10-2: Total patients with end-stage kidney disease, by Indigenous status and treatment, as at 31 December 2017

Treatment

Indigenous Number

Non-Indigenous Number

Indigenous

Number per 100,000

(age-standardised)

Non-Indigenous

Number per 100,000

(age-standardised)

Rate Ratio

Dialysis

1,884

10,835

374.3

38.8

9.7*

Transplant

272

11,080

49

42.8

1.1

Total

2,156

21,915

423.3

81.5

5.2*

* Represents results with statistically significant differences at the p < 0.05 level in the Indigenous/non-Indigenous comparisons.

Source: Table D1.10.14. AIHW analysis of ANZDATA data.

Between 2011 and 2018, the prevalence of treated end-stage kidney disease among Indigenous Australians increased from 209 to 269 per 100,000 (Table D1.10.16).

In 2014–2018, Indigenous patients who were receiving treatment for end-stage kidney disease at the time of their death were most commonly receiving treatment with dialysis (45 per 100,000), followed by transplant (1.9 per 100,000). For non-Indigenous patients, the rate was 5.5 per 100,000 for dialysis and 0.8 per 100,000 for transplant.

Among Indigenous dialysis patients who died in 2014–2018, cardiovascular disease was the most common cause of death (35% of deaths), followed by withdrawal from dialysis (23%). The two most common causes of death among non-Indigenous dialysis patients were also withdrawal from dialysis (34% of deaths) and cardiovascular disease (30%) (Table D1.10.17).

Findings from ABS survey data

Based on the 2012–13 Australian Aboriginal and Torres Strait Islander Health Survey (Health Survey), nearly 1 in 5 (18%) Indigenous Australian adults had blood/urine test results showing signs of kidney problems (infection, acute or chronic condition). Of these, the majority (12%) showed signs of being in the lowest category (Stage 1), very few (1.1 %) were in the most severe categories (Stages 4–5).

Of Indigenous Australians with indicators of chronic kidney disease in the 2012–13 Health Survey, only 11% had self-reported having the condition and 89% of those with indicators did not know they had it (ABS 2014).

Based on self-reported data from the 2018–19 National Aboriginal and Torres Strait Islander Health Survey, 3.4% of Indigenous adults reported having chronic kidney disease, 3 times the rate of non-Indigenous adults (1.1%), after adjusting for differences in the age structure between the two populations.

The rate of chronic kidney disease for Indigenous Australians increased with age, from 0.1% for those aged 18–24, to 7.6% for those aged 55 and over. The rates for non-Indigenous Australians followed a similar pattern with rates increasing from 0.5% for those aged 25–34, to 2.5% for those aged 55 and over.

Indigenous Australians living in Remote areas were 2.3 times as likely as those living in Non-remote areas to report having chronic kidney disease (6.4% and 2.8%, respectively) (Table D1.10.1).

In 2018–19, Indigenous adults who rated their health as fair/poor were 3 times as likely to self-report having kidney disease compared with those rating their health as excellent/very good/good (5.8% compared with 1.7%). Indigenous adults who self-reported having diabetes were 5 times as likely to self-report having kidney disease compared with those without diabetes (9.2% compared with 1.7%). Indigenous adults reporting heart/circulatory problems were 8 times as likely to self-report having kidney disease compared with those without heart/circulatory problems (8.1% compared with 1.0%). Indigenous Australians who were obese were twice as likely to self-report having kidney disease compared with those who were underweight/normal weight (3.8% compared with 1.9%) (Table D1.10.2).

What do research and evaluations tell us?

A significant amount of research has gone towards understanding the antecedents of kidney disease among Indigenous Australians, particularly in remote areas. Reviews of the literature have highlighted that kidney disease is multi-determinant, with risk factors including nutritional and developmental disadvantage, low birthweight, childhood infections, family history of kidney disease, as well as adult onset chronic diseases such as hypertension, and diabetes (Hoy 2014; Stumpers & Thomson 2013). Modifiable risk factors also exist including tobacco smoking, overweight and obesity, and insufficient physical activity (Australian Institute of Health and Welfare 2018).

Kidney disease represents a major challenge for patients and the health system. Due to the high costs associated with dialysis and transplantation, kidney disease costs the Australian health system an estimated $5.1 billion each year (Kidney Health Australia 2020). Kidney health care is also logistically difficult, with challenges associated with diagnosing and treating kidney disease in remote Australia. Research shows that barriers in remote areas include not only accessing treatment, but also accessing appropriate information and education (Garrard et al. 2019). Flow-on effects from this include significant disruption to wellbeing, disempowerment and disconnection with communities from being away, and reveals challenges within the health care system in terms of cultural competency and equity (Hoy 2014; Stumpers & Thomson 2013).

Indigenous patients with end-stage kidney disease are less likely to be wait-listed for transplantation than non-Indigenous Australians (Khanal et al. 2018). The health system may pose barriers to accessing transplantation for Indigenous Australians such as reduced likelihood of referral for transplant evaluation; lack of comprehensive investigation of Indigenous patients; and communication and education limitations. There may also be individual patient factors that pose barriers such as incompatibility, higher rates of co-morbidities which affect the acceptability of a kidney transplant, and lower compliance to medical treatment as a result of communication problems (Stumpers & Thomson 2013). Geographic factors may also act as a barrier to transplantation, with research showing that Indigenous patients are not only less likely to be waitlisted for a transplant, but that this disparity increases with remoteness (Garrard et al. 2019; Khanal et al. 2018).

A study of Australian nephrologists found that, in the absence of robust evidence on predictors of post-transplant outcomes, decisions on which patients to refer for kidney transplants were influenced by factors such as kidney shortages, compliance with dialysis as a predictor of compliance with transplant regimes (despite large differences in these factors), and experiences with other Indigenous patients (Anderson et al. 2012). Some of these issues are based on miscommunication between health care provider and patient, and a lack of appropriate patient education. This may lead to generalisations about the patient’s circumstances and therefore result in a bias towards considering Indigenous patients as high risk. Recognising and responding to these cultural differences appropriately will be crucial to improving the management of Indigenous patients. A more systematic approach to monitoring compliance to dialysis and transplant treatment for Indigenous patients will assist in basing referral decisions on evidence (Anderson et al. 2012; Garrard et al. 2019).

High rates of Indigenous Australians in remote areas requiring dialysis leads to patients leaving their homes, communities and country to visit dialysis services in non-remote areas. Recent research found that almost one quarter (23.9%) of Australian renal replacement therapy patients between 2005 and 2015 relocated, with patients relocating more frequently and earlier from outer regional, remote and very remote areas towards major cities and inner regional areas (Hassan et al. 2020).This disruption impacts the health and wellbeing of patients. The South Australian Mobile Dialysis Truck allows patients to have dialysis closer to home for one to two week periods. An evaluation of the program found it improved the social and emotional wellbeing of patients by allowing them to fulfil cultural commitments and improved patient quality of life, as well as build positive relationships and trust between metropolitan nurses and remote patients. The Truck may also serve to improve cultural competency of health staff (Conway et al. 2018) (for more information see measure 2.13 Transport).

Implications

Reducing the chronic kidney disease burden for Indigenous Australians requires targeted interventions across the life course, starting before birth (Cass 2019). A focus on the health and social determinants, improving primary prevention, early detection and better management of kidney disease is necessary to lessen the impact on patients, and to reduce the cost to the health care system (Cass et al. 2004). Strategies could include more patient education and better management of modifiable risk factors such as controlling blood pressure, controlling high blood sugar levels, quitting smoking, maintaining a healthy diet and being physically active.

Mainstream service providers and specialists need to be culturally competent to better assist Indigenous Australians, particularly from remote areas, to navigate the kidney disease continuum. Communication issues are a barrier to care and are frustrating for patients as well impacting on treatment outcomes (Anderson et al. 2008) (The George Institute for Global Health 2011). Where possible, Indigenous health practitioners and interpreters should be used in clinical interactions to overcome any cultural barriers.

Despite improved availability of services, disparities between Indigenous and non-Indigenous Australians in receiving kidney transplants remain. This may be a reflection of flow-on effects of Indigenous patients from remote areas undergoing dialysis which result in barriers to transplantation assessment, as well as factors such as cultural differences and communication issues within the health care system (as mentioned above). Reducing the disruption experienced by patients relocating for dialysis treatment may in turn improve clinical assessment for transplantation which may then improve the access of Indigenous patients to kidney transplantation (Khanal et al. 2018). For patients on dialysis, innovative use of mobile dialysis treatment can provide respite for patients closer to home to help maintain cultural obligations and connection to family and country, it may also improve the cultural competency of health care staff. In addition to the South Australian Mobile Dialysis Truck discussed above, another example of a mobile dialysis unit on wheels is The Purple Truck. Operating in remote communities in Central Australia, The Purple Truck has two dialysis chairs and enables Indigenous Australians with end-stage kidney disease to return to their traditional country and re-engage with Elders, family and their community (Western Desert Nganampa Walytja Palyantjaku Tjutaku Aboriginal Corporation).

In 2019 a National Indigenous Kidney Transplantation Taskforce (NIKTT) was established, responsible for implementing and evaluating the recommendations outlined in a comprehensive review into the hurdles, service gaps and practical challenges faced by Indigenous Australians receiving treatment for kidney disease (The Transplantation Society of Australia and New Zealand). Key objectives of the Taskforce include enhancing data collection and reporting, piloting initiatives to improve patient equity and access, and evaluating cultural bias interventions (National Indigenous Kidney Transplantation Taskforce 2020).

Having better integrated data collections can expand the knowledge base for guiding health policy and funding activities, and can help improve understanding of the joint role of diseases on death (AIHW 2012, 2014b). A fuller capture of deaths for which kidney disease is an associated cause of death, rather than limited to the underlying cause of death, would help provide a greater understanding of the burden of Indigenous kidney disease that is not currently well understood, which in turn will assist policy development (Hoy et al. 2020).

The policy context is at Policies and strategies.

References

  • ABS (Australian Bureau of Statistics) 2014. Australian Aboriginal and Torres Strait Islander Health Survey: Biomedical Results 2012–13. Cat. no. 4727.0.55.003. Canberra: AIHW.
  • AIHW (Australian Institute of Health and Welfare) 2011. Chronic kidney disease in Aboriginal and Torres Strait Islander people 2011 Canberra: AIHW.
  • AIHW 2012. Multiple causes of death An analysis of all natural and selected chronic disease causes of death 1997-2007. Canberra: AIHW.
  • AIHW 2014a. Assessment of the coding of ESKD in deaths and hospitalisation data: a working paper using linked hospitalisation and deaths data from Western Australia and New South Wales. Cat. no. PHE 182. (ed., AIHW). Canberra: AIHW.
  • AIHW 2014b. Assessment of the coding of ESKD in deaths and hospitalisation data: a working paper. Canberra: AIHW.
  • AIHW 2015. Cardiovascular disease, diabetes and chronic kidney disease—Australian facts: Aboriginal and Torres Strait Islander people. Cat. no. CDK 5. (ed., AIHW). Canberra: AIHW.
  • AIHW 2016a. Diabetes and chronic kidney disease as risks for other diseases: Australian Burden of Disease Study 2011. Canberra: AIHW.
  • AIHW 2016b. Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011. Australian Burden of Disease Study series 6. Cat. no. BOD 7. Canberra: AIHW.
  • AIHW 2018. Australia's Health 2018 (Cat. No. AUS 221; Australia's Health Series No. 16).
  • AIHW 2020. Chronic kidney disease. Canberra: AIHW. Viewed 17 September.
  • Anderson K, Devitt J, Cunningham J, Preece C & Cass A 2008. “All they said was my kidneys were dead”: Indigenous Australian patients’ understanding of their chronic kidney disease. Medical Journal of Australia 189:499-503.
  • Anderson K, Devitt J, Cunningham J, Preece C, Jardine MJ & Cass A 2012. If you can't comply with dialysis, how do you expect me to trust you with transplantation? Australian nephrologists' views on indigenous Australians' 'non-compliance' and their suitability for kidney transplantation. International Journal for Equity in Health 11:21.
  • Cass A 2019. Kidney disease in indigenous populations. Darwin: Menzies School of Health Research.
  • Cass A, Cunningham J, Snelling P, Wang Z & Hoy W 2004. Exploring the pathways leading from disadvantage to end-stage renal disease for Indigenous Australians. Social Science & Medicine 58:767-85.
  • Chadban S, McDonald S, Excell L, Livingstone B & Shtangey V 2005. Twenty Eighth Report: Australia and New Zealand Dialysis and Transplant Registry 2005. (ed., Commonwealth Department of Health and Ageing with Kidney Health Australia & New Zealand Ministry of Health). Adelaide: ANZDATA Registry.
  • Conway J, Lawn S, Crail S & McDonald S 2018. Indigenous patient experiences of returning to country: a qualitative evaluation on the Country Health SA Dialysis bus. BMC health services research 18:1010.
  • Devitt J, Cass A, Cunningham J, Preece C, Anderson K & Snelling P 2008. Study Protocol--Improving Access to Kidney Transplants (IMPAKT): a detailed account of a qualitative study investigating barriers to transplant for Australian Indigenous people with end-stage kidney disease. BMC health services research 8:31.
  • Garrard E, McDonald S, Gorham G, Rohit A & Triggs C 2019. Improving Access to and Outcomes of Kidney Transplantation for Aboriginal and Torres Strait Islander People in Australia: Performance Report. The Transplantation Society of Australia and New Zealand.
  • Hassan HIC, Chen JH & Murali K 2020. Incidence and factors associated with geographical relocation in patients receiving renal replacement therapy. BMC nephrology 21:1-8.
  • Hoy WE 2014. Kidney disease in Aboriginal Australians: a perspective from the Northern Territory. Clinical kidney journal 7:524-30.
  • Hoy WE, Mott SA & McDonald SP 2020. An update on chronic kidney disease in Aboriginal Australians. Clinical nephrology 93:124-8.
  • Johnson D 2004. Evidence‐based guide to slowing the progression of early renal insufficiency. Internal Medicine Journal 34:50-7.
  • Khanal N, Lawton PD, Cass A & McDonald SP 2018. Disparity of access to kidney transplantation by Indigenous and non‐Indigenous Australians. Medical Journal of Australia 209:261-6.
  • Kidney Health Australia. Know your Kidneys. Viewed September 2020.
  • Kidney Health Australia 2020. Chronic Kidney Disease (CKD) Management in Primary Care (4th edition). Melbourne.
  • National Indigenous Kidney Transplantation Taskforce 2020. Performance Report February 20.
  • Rix EF, Barclay L, Stirling J, Tong A & Wilson S 2015. The perspectives of Aboriginal patients and their health care providers on improving the quality of hemodialysis services: A qualitative study. Hemodialysis International: International Symposium on Home Hemodialysis 19:80-9.
  • Stumpers SA & Thomson NJ 2013. Review of kidney disease among Indigenous people.
  • Sypek MP DK, Clayton P, Webster AC & McDonald S 2018. Comparison of cause of death between Australian and New Zealand Dialysis and Transplant Registry and the Australian National Death Index. Nephrology 24:322-9.
  • The George Institute for Global Health 2011. Central Australia Renal Study. Canberra Office for Aboriginal and Torres Strait Islander Health within the Department of Health and Ageing.
  • The Transplantation Society of Australia and New Zealand. National Indigenous Kidney Transplantation Taskforce (NIKTT)
  • Western Desert Nganampa Walytja Palyantjaku Tjutaku Aboriginal Corporation. The Purple Truck

View measure data

View data visualisations, download data tables and review data sources for this measure.

Data