Useful weblinks: CKD in Australia (for Health Professionals)
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Kidney Health Australia in collaboration with the National Rural Health Alliance has prepared Fact Sheet No 35 (March 2013) Kidney Disease in Rural Australia
STATE OF THE NATION - CHRONIC KIDNEY DISEASE IN AUSTRALIA May 2014
CKD is common: Around 1.7 million Australians (1 in 10) aged 18 years and over have clinical evidence of chronic kidney disease (CKD). However, as CKD typically has no symptoms, less than 10% of the people with CKD are aware they have this condition.This means over 1.5 million Australians are unaware they have indicators of CKD. The most visible outcome of CKD is end stage kidney disease (ESKD); people with ESKD require dialysis or a kidney transplant (together called renal replacement therapy) to stay alive.
There are currently 20,766 people in Australia who are on renal replacement therapy. However, people with CKD are up to 20 times more likely to die from a heart attack or stroke than they are to receive dialysis.
Read State of the Nation - CKD May 2014>
FAST FACTS ON CKD
Did you know that a person can lose up to 90% of their kidney function before experiencing any symptoms?
Chronic Kidney Disease (CKD) is a significant and growing public health problem, responsible for substantial burden of illness and premature mortality.
HOW MANY PEOPLE HAVE CKD?
- Approximately 1.7 million Australians (1 in 10) aged 18 years and over have indicators of CKD such as reduced kidney function and/or the presence of albumin in the urine1.
- Less than 10% of the people with CKD are aware they have this condition2.
- This means over 1.5 million Australians are unaware they have indicators of CKD.
WHO IS AT INCREASED RISK OF CKD?
- 1 in 3 Australians is at an increased risk of developing CKD3.
- Adult Australians are at an increased risk of CKD if they:
- are 60 years or older
- have diabetes
- have a family history of kidney disease
- have established heart problems (heart failure or heart attack) and/or have had a stroke
- have high blood pressure
- are obese (Body Mass Index (BMI) - more than or equal to 30)
- are a smoker
- are of Aboriginal or Torres Strait Islander origin
- The greater prevalence of CKD in some Indigenous Australian communities is due to the high incidence of traditional risk factors including diabetes, high blood pressure and smoking4, in addition to increased levels of inadequate nutrition, alcohol abuse, streptococcal throat and skin infection, and poor living conditions5.
WHAT CAUSES KIDNEY FAILURE?
Data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry shows that the three most common causes of kidney disease requiring renal replacement therapy (dialysis or transplant) in Australia in 2012 were diabetes, glomuleronephritis (inflammation of the kidney) and hypertension (high blood pressure)6:
WHY WORRY ABOUT CKD?
In Australia, CKD is:
KIDNEY DISEASE AMONG ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLE
- 10% of people attending general practice have CKD, but most do not know it7.
- 42% of people over 75 years of age have an indicator of CKD1.
- People with CKD have a 2 to 3-fold greater risk of cardiac death than people without CKD8.
- For people with CKD, the risk of dying from cardiovascular events is 20 times greater than the risk of requiring dialysis or transplantation9.
- If CKD is detected early and managed appropriately, then the otherwise inevitable deterioration in kidney function can be reduced by as much as 50% and may even be reversible10.
TREATMENT FOR KIDNEY FAILURE
- The incidence of kidney failure is considerably greater in Aboriginal and Torres Strait Islander people compared with non-Indigenous people11.
- After adjusting for age differences, kidney disease is around 3.7 times more common among Indigenous people than among non-Indigenous people12.
- The incidence of end stage kidney disease for Indigenous peoples is especially high in remote and very remote areas of Australia, with rates almost 18 times and 20 times those of comparable non-Indigenous peoples13.
- Although Aboriginal and Torres Strait Islander people represent less than 2.5% of the national population, they account for approximately 9% of people commencing kidney replacement therapy each year.
- Aboriginal and Torres Strait Islander people are almost 4 times as likely to die with CKD as a cause of death than non-Indigenous Australians14.
Most recent data from Australia & New Zealand Dialysis and Transplant (ANZDATA) Registry15 shows:
- 2,534 people started kidney replacement therapy (dialysis or transplant) in 2012.
- 20,756 people were receiving renal replacement therapy - dialysis or kidney transplantation - at the end of 2012. This represents a 6.6% increase from 2011.
- 22% of people who begin kidney replacement therapy are referred ‘late’ to a nephrologist - i.e. less than 3 months before beginning kidney replacement therapy.
- in Australia, late referral is more common among people of Pacific Islands (29%), Indigenous Australian (29%) or Maori (26%) origin, compared with the Caucasian population (22%).
- A total of 11,446 people were receiving dialysis treatment at the end of 2012.
- This presents an increase of 4.1% from 2011.
- Of all people on dialysis, 29% dialyse at home.
- Dialysis treatments at the end of 2012:
- 8% use Continuous Ambulatory Peritoneal Dialysis
- 12% use Automated Peritoneal Dialysis
- 9% use Home Haemodialysis
- 71% use satellite or hospital dialysis
- In 2012, home dialysis as a percentage of all dialysis increased in Queensland (31%), Australian Capital Territory (22%), Victoria 24% and South Australia (22%) from 2011 figures.
- 845 kidney transplant operations were performed in Australia in 2012.
- A total of 9,320 Australians were alive as a result of a functioning kidney transplant at the end of 2012 - this represents a 9.8% increase from 2011.
- As at July 2014 - 1,144 people were waiting for a kidney transplant in Australia16.
- 73% of people on the waiting list are aged less than 60 years, and 79% are waiting for their first transplant.
- The average waiting time for a transplant is about 3.5 years, but waits of up to 7 years are not uncommon 17.
- The survival rate following a kidney transplant is high - 98% of recipients are alive at 1 year and 89% are alive at 5 years.
- In 2013 there were 391 deceased organ donors in Australia, who saved or improved the lives of 1,122 people18.
- In 2013 outcome represents a 10% increase from the previous year.
- The 2013 outcome represents a 10% increase from the previous year.
- There were 249 live kidney donations in 2013, a 5% increase on 2012.
Graphic of existing (and projections for 2009 to 2020) for End Stage Kidney Disease in Australia
THE COST TO THE AUSTRALIAN HEALTH SYSTEM
- The best available evidence19 we have on cost per person per year on dialysis is:
- The costs of treating end-stage kidney disease from 2009 to 2020 is estimated to be around $12 billion to the Australian Government.
- Increasing the use of Home Dialysis over the next 10 years is estimated to lead to net savings of between $378 and $430 million for the health system.
- Kidney disease contributes to approximately 15% of all hospitalisations in Australia.
HOW MANY AUSTRALIANS DIE FROM KIDNEY FAILURE?
The most recent data available from the Australian Bureau of Statistics20 show:
For individuals with kidney failure, palliative care can provide support with symptom management, advance care planning, psychological support and education for both patients and their families
In Australia 21
- Kidney failure (as a principal or additional diagnosis) is the 3rd most common cause of palliative care-related hospital separations (behind secondary cancer and lung cancer).
- Kidney failure as the principal diagnosis accounts for 36% of all palliative care patient deaths.
Kidney Health Australia proudly supports and collaborates with the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) which provides detailed annual reports and six-monthly interim summaries (from 1997 to present), detailing statistics on the incidence, prevalence and outcome of dialysis and transplant treatment for patient with end stage kidney failure.
OTHER USEFUL AUSTRALIAN CKD REFERENCES
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STATISTICS REFERENCE LIST - Page updated 24 July 2014
(1) Australian Bureau of Statistics. Australian Health Survey: Biomedical Results for Chronic Diseases, 2011-12. ABS, Canberra; 2013
(2) Australian Bureau of Statistics. Australian health survey: First results 2011-12. 2012. Report No.: 4364.0.55.001
(3) Chadban SJ, Briganti EM, Kerr PG et al. Prevalence of kidney damage in Australian adults: The AusDiab kidney study. J Am Soc Nephrol 2003 July;14(7 Suppl 2):S131-S138
(4) Australian Institute of Health and Welfare (AIHW). The health and welfare of Australia's Aboriginal and Torres Strait Islander people: an overview 2011. 2011
(5) Cass A, Cunningham J, Hoy W. The relationship between the incidence of end-stage renal disease and markers of socioeconomic disadvantage. New South Wales Public Health Bulletin 2002 July;13(7):147-51
(6) ANZDATA. Summary of Australia and New Zealand Dialysis and Transplantation, 2012. Australia and New Zealand Dialysis and Transplant Registry, South Australia, Adelaide 2013
(7) Australian Institute of Health. BEACH-SAND Report. Bettering the evaluation and care of health. Chronic renal failure/kidney disease 2007
(8) Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998;32:S112-S119
(9) Keith DS, Nichols GA, Gullion CM, Brown JB, Smith DH. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Archives of Internal Medicine 2004 March 22;164(6):659-63
(10) Johnson DW. Evidence-based guide to slowing the progression of early renal insufficiency. Intern Med J 2004 January; 34(1-2):50-7
(11) ANZDATA. The 35th ANZDATA Registry Report. Australia and New Zealand Dialysis and Transplant Registry, South Australia, Adelaide; 2013
(12) Australian Bureau of Statistics. Australian Aboriginal and Torres Strait Islander people Health Survey Updated results, Australia, 2012-13 . 2014
(13) Stumpers S, Thomson N. Review of kidney disease among Indigenous people. Australian Indigenous Health Bulletin 2013;13(2)
(14) Australian Institute of Health and Welfare. Chronic Kidney Disease in Aboriginal and Torres Strait Islander people 2011. Canberra Australia: AIHW; 2011. Report No.: Cat. No. PHE 151
(15) ANZDATA. The 36th Annual ANZDATA Report. Australia and New Zealand Dialysis and Transplant Registry, South Australia, Adelaide; 2014
(16) National Organ Matching System. Australian waiting list. Australian and New Zealand Organ Donation Registry 2013; Available at: URL: http://www.anzdata.org.au/anzod/v1/waitinglist2013.html
(17) Wright J, Narayan S. Analysis of kidney allocation during 2012. National Organ Matching System www.tsanz.com.au/downloads/2012-NOMSAnalysis.pdf; 2013
(18) Australian Government Organ and Tissue Authority. Performance Report 2013. 2014.
(19) Cass A, Chadban S, Gallagher M et al. The economic impact of end-stage kidney disease in Australia: Projections to 2020. Kidney Health Australia, Melbourne, Australia; 2010.
(20) Australian Bureau of Statistics. Causes of death, 2012. 2014
(21) Australian Institute of Health & Welfare. Palliative care services in Australia in 2013. HWI 123, Canberra: AIHW; 2013.