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 Report>
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 urine.1
- Less than 10% of the people with CKD are aware they have this condition.2
- 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 CKD.3
- Adult Australians are at an increased risk of CKD if they:
- have diabetes
- have high blood pressure
- have established heart problems (heart failure or heart attack) and/or have had a stroke
- have a family history of kidney disease
- are obese (Body Mass Index (BMI) - more than or equal to 30)
- are a smoker
- are 60 years or older
- are of Aboriginal or Torres Strait Islander origin
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).4
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 it.5
- 42% of people over 75 years of age have an indicator of CKD.1
- People with CKD have a 2 to 3-fold greater risk of cardiac death than people without CKD.6
- For people with CKD, the risk of dying from cardiovascular events is 20 times greater than the risk of requiring dialysis or transplantation.7
- 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 reversible8.
- In 2012-11 almost 1 in 5 (18%) Aboriginal and Torres Strait Islander people aged >18 years had indicators of CKD.9
TREATMENT FOR KIDNEY FAILURE
- After adjusting for age differences, Aboriginal and Torres Strait Islander people were more than twice as likely as non-Indigenous people to have indicators of CKD. They were 3 times as likely to have indicactors of Stage 1 CKD, and more than 4 times as likely as non-Indigenous people to have indicators of Stage 4-5.9
- 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 peoples.10
- Around 9 in 10 Aboriginal and Torres Strait Islander people with signs of CKD were not aware they had it.9
- 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 Australians.11
Most recent data from Australia & New Zealand Dialysis & Transplant (ANZDATA) Registry4 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 Australia.12
- 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.13
- 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 people.14
- 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 evidence15 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 PEOPLE DIE FROM KIDNEY FAILURE?
The most recent data available from the Australian Bureau of Statistics16 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
- 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 September 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) ANZDATA. The 36th Annual ANZDATA Report. Australia and New Zealand Dialysis and Transplant Registry, South Australia, Adelaide; 2014.
(5) Australian Institute of Health. BEACH-SAND Report. Bettering the evaluation and care of health. Chronic renal failure/kidney disease. 2007.
(6) Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998;32:S112-S119.
(7) 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. Arch Intern Med 2004 March 22;164(6):659-63.
(8) Johnson DW. Evidence-based guide to slowing the progression of early renal insufficiency. Intern Med J 2004 January;34(1-2):50-7.
(9) Australian Bureau of Statistics. Australian Aboriginal and Torres Strait Islander Health Survey: Biomedical Results, 2012-13. 2014. Report No.: 4727.0.55.003, Canberra.
(10) Stumpers S, Thomson N. Review of kidney disease among Indigenous people. Australian Indigenous Health Bulletin 2013;13(2).
(11) 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.
(12) National Organ Matching System. Australian waiting list. Australian and New Zealand Organ Donation Registry 2013; Available at: URL: www.anzdata.org.au/anzod/v1/waitinglist2013.html.
(13) Wright J, Narayan S. Analysis of kidney allocation during 2013. 2014.
(14) Australian Government Organ and Tissue Authority. Performance Report 2013. 2014.
(15) 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.
(16) Australian Bureau of Statistics. Causes of death, 2012. 2014.
(17) Lozano R, Naghavi M, Foreman K et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2095-128.
(18) Australian Institute of Health and Welfare. Palliative care services in Australia in 2013. HWI 123, Canberra: AIHW; 2013.