End-stage renal disease (ESRD) and renal

replacement therapy (RRT) in the

Australian Indigenous population
Why are the rates so high, and how well
are we providing care?

Adrian Castro
Role of the kidneys
Continuous filtration of blood
1

Clearance of waste products
Homeostasis of amount of body water and other
substances
Production of important hormones
1

Erythropoietin RBC production
Renin cascade of renin-angiotensin-aldosterone
system homeostasis of blood pressure

What is chronic kidney
disease (CKD) and ESRD?
CKD refers to any kidney damage and/or
reduced kidney function lasting at least 3
months irrespective of the causative disease or
condition
2
CKD is classified into five stages according to GFR
ESRD is the most severe form of CKD stage 5
1

Renal replacement therapy (RRT) in the form of
dialysis or a kidney transplant is required to survive
ESRD epidemiology
Almost 10% of new cases of treated ESRD
were for Indigenous Australians
3

This is despite them only making up 2.5% of the
total Australian population
Indigenous Australians are 4 times more likely
to die with CKD as a cause of death than non-
Indigenous Australians
3

ESRD epidemiology
In comparing the total numbers of Indigenous and non-
Indigenous people with ESRD it was found that there
was a 88.2% overall excess proportion of Indigenous
people with ESRD
3

Main causes of ESRD
3

Diabetes
Glomerulonephritis
High blood pressure
Why are rates of CKD so high in the
Indigenous population?
Many people with CKD dont know they have it
because symptoms often dont appear until 90%
of kidney function is lost
3

i.e. CKD is a silent killer
Indigenous Australians have higher levels of risk
factors associated with chronic disease including
smoking, sedentary lifestyle and obesity
4

Other increased factors for the development of
CKD are low birth weight and inflammation
secondary to increased infections
4


Why are rates of CKD so high in the
Indigenous population?
Other factors that have been linked to CKD
and correlate strongly with ESRD in Indigenous
Australians are:
5,6

Primary kidney disease
Genetics
Early development and socioeconomic
disadvantage (house crowding, educational
attainment, employment and income)
Accelerated lifestyle change
How well are we providing care?
Overall, most studies have found that
Indigenous Australians typically have worse
outcomes in terms of mortality rates and
transplant failure
7,8,9,10

One study found that there was little
difference in mortality rates between
Indigenous and non-Indigenous patients
undergoing dialysis in remote areas
11

How well are we providing care?
Indigenous patients do not access health services
as often as other Australians and many
communities dont have ready access to
services
12

Reasons for this disparity in access are difficulties with
spoken and written English, lack of available
transport, financial difficulties and proximity of
culturally appropriate health-care services
These are all factors that need to be addressed in
order to Close the Gap between the outcomes for
Indigenous people and non-Indigenous people with
CKD/ESRD
References
1. Kidney Health Australia 2007. Chronic kidney disease (CKD) management in general practice. Melbourne: Kidney
Health Australia.
2. National Kidney Foundation of America 2002. K/DOQI clinical practice guidelines for chronic kidney disease:
evaluation, classification, and stratification. American Journal of Kidney Disease 39:S1266.
3. Australian Institute of Health and Welfare 2011. Chronic kidney disease in Aboriginal and Torres Strait Islander
people 2011. Cat. no. PHE 151 Canberra: AIHW.
4. Hoy WE, Hughson MD, Singh GR, Douglas-Denton R & Bertram JF 2006. Reduced nephron number and
glomerulomegaly in Australian Aborigines: a group at high risk for renal disease and hypertension. Kidney
International 70:10410.
5. Cass A, Cunningham J, Snelling P, Wang Z & Hoy W 2002. End-stage renal disease in Indigenous Australians: a
disease of disadvantage. Ethnicity and Disease 12:3738.
6. Hoy WE, Mathews JD, McCredie DA, Pugsley DJ, Hayhurst BG, Rees M et al. 1998. The multidimensional nature of
renal disease: rates and associations of albuminuria in an Australian Aboriginal community. Kidney International
54:1296304.
7. Spencer JL, Silva DT, Snelling P & Hoy WE 1998. An epidemic of renal failure among Australian Aboriginals. Medical
Journal of Australia 168:53741.
8. McDonald SP & Russ GR 2003. Current incidence, treatment patterns and outcome of end-stage renal disease
among Indigenous groups in Australia and New Zealand. Nephrology 8:428.
9. McDonald S 2004. Indigenous transplant outcomes in Australia: what the ANZDATA Registry tells us. Nephrology
(Carlton) 9 Suppl 4:S138-43.
10. Rogers NM, Lawton PD & Jose MD 2006. Kidney transplant outcomes in the Indigenous population in the Northern
Territory of Australia. Transplantation 82:8826.
11. Marley JV, Dent HK, Wearne M, Fitzclarence C, Nelson C, Siu K et al. 2010. Haemodialysis outcomes of Aboriginal
and Torres Strait Islander patients of remote Kimberley region origin. Medical Journal of Australia 193:51620.
12. ABS & AIHW 2008. The health and welfare of Australias Aboriginal and Torres Strait Islander peoples 2008. ABS
cat. no. 4704.0. AIHW cat. no. IHW 21. Canberra: ABS & AIHW.