Chronic kidney disease (CKD) refers to all conditions of the kidney affecting the filtration and removal of waste from the blood for 3 months or more. CKD is identified by reduced filtration by the kidney and/or by the leakage of protein or albumin in the urine. CKD is mostly diagnosed at more advanced stages when symptoms become more visible. End-stage kidney disease (ESKD) is the most severe form of CKD where people usually require kidney replacement therapy (KRT)—a kidney transplant or dialysis—to survive.

CKD is largely preventable because many of its risk factors—high blood pressure, tobacco smoking, overweight and obesity, and impaired glucose regulation—are modifiable. Early detection of CKD by simple blood or urine tests enables treatment to prevent or slow down its progression.

How common is chronic kidney disease?

In 2011⁠–⁠12, an estimated 1 in 10 people (1.7 million Australians) aged 18 and over had biomedical signs of CKD, according to the Australian Bureau of Statistics’ (ABS) latest National Health Measure Survey in 2011⁠–⁠12 (AIHW 2014). The risk of CKD increases rapidly with age, affecting around 4 in 10 (42%) people aged 75 and over.

Early stages of CKD are often underdiagnosed as there are no apparent signs or discomfort to the person. CKD is a largely underdiagnosed condition—only 10% of survey respondents who showed biomedical signs of CKD reported having CKD.

Between 1999⁠–⁠2000 and 2011⁠–⁠2012, the CKD prevalence rate remained stable, but the number of Australians with moderate to severe loss of kidney function nearly doubled (from 322,000 in 1999⁠–⁠2000 to 604,000 in 2011⁠–⁠2012). This increase was mostly driven by growth in the population of older people (as people live longer) and survival of people with advanced stages of CKD receiving KRT (AIHW 2018).

There were around 5,100 new cases of end-stage kidney disease in Australia in 2013, which equates to around 14 new cases per day. Of these, around 50% were receiving KRT.

The rate of new cases of KRT-treated and non-KRT-treated ESKD increased with age for all age groups to the age of 74. From age 75, only rates of non-KRT-treated ESKD rose rapidly—an 11-fold increase from age 65⁠–⁠74 (from 13 to 145 per 100,000 population) (Figure 1). The relative contribution of persons newly diagnosed with ESKD and receiving KRT to the overall incidence rate decreases significantly with age: 9 in 10 (92%) new patients with ESKD aged under 55 have received KRT compared with 1 in 5 (19%) new patients with ESKD aged 75 and over.

This chart shows the (age standardised) incidence rate of end stage kidney disease (ESKD) in 2013 by age group and treatment status, from the AIHW analysis of the linked ANZDATA, AIHW National Mortality Database and National Death Index.

The treatment rate for new patients with ESKD increased slightly with age from 4.8 per 100,000 population among persons aged under 55 to 35 per 100,000 population among persons aged 75 and over. In contrast, the rate of new patients with ESKD who did not get any KRT treatment increased sharply from 0.4 per 100,000 population among those aged under 55 to 145 per 100,000 population among those aged 75 and over. These age patterns are similar for men and women with higher ESKD incidence rates observed for males.

Between 1997 and 2013, the number of new cases of KRT-treated and non-KRT-treated ESKD increased by 71% and 35% respectively. However, the rate for both treatment groups has remained relatively stable since 2001—an average of 10 per 100,000 population per year (Figure 2).

This graph shows the rate of new ESKD cases by treatment status from 1997 to 2013. Over the years the incidence of both KRT and non-KRT treatments have remained relatively stable at around 10 cases per 100,000 population for both groups. Small fluctuations are observed on the chart.

Impact

Burden of disease

The contribution of CKD to the total disease burden (fatal and non-fatal) in Australia has increased since 2003. In 2015, CKD was responsible for 1.2% of the total burden compared with 0.8% in 2003. The burden of CKD increased rapidly with age, with CKD being the seventh leading cause of burden among those aged 85 and over.

Impaired kidney function contributes to the burden of CKD as well as several other diseases, including gout, peripheral vascular disease, dementia, coronary heart disease and stroke. In 2015, 2.1% of total disease burden could have been prevented if people had not had impaired kidney function (AIHW 2019b).

See Burden of disease.

Deaths

According to the National Mortality Database, CKD contributed to around 16,800 (11%, or 1 in 9) deaths in 2018, with 79% of these recording CKD as an associated cause of death (AIHW 2019d). CKD is more often recorded as an associated cause as the disease itself may not lead directly to death. When CKD was an associated cause of death, the most common underlying causes of death were:

  • diseases of the circulatory system (37%), such as coronary heart disease and heart failure and cardiomyopathy
  • cancers (19%) such as prostate, lung, blood and bladder cancer
  • diseases of the respiratory system (8.8%) such as COPD and pneumonia
  • endocrine, nutritional and metabolic diseases (8.8%), in particular type 2 diabetes
  • dementia and Alzheimer’s disease (7.6%).

CKD is often under-reported as a cause of death, as shown by linked data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) registry and National Death Index, in which over half (53%) of the patients with ESKD who received KRT and died during the period 1997⁠–⁠2013 did not have ESKD recorded on their death certificate (AIHW 2016b).

See Causes of death.

Treatment and management

Hospitalisations

According to the National Hospital Morbidity Database, in 2017⁠–⁠18, CKD was recorded as the principal or additional diagnosis in around 1.9 million hospitalisations—17% of all hospitalisations in Australia (AIHW 2019c). Of these, 80% (1.5 million) were for regular dialysis treatment, making dialysis the most common reason for hospitalisation (AIHW 2019a). Age-standardised rates for dialysis have increased by 19% over the last decade, from 4,500 per 100,000 population in 2007⁠–⁠08 to 5,400 per 100,000 population in 2017⁠–⁠18.

There were 370,000 hospitalisations with a diagnosis of CKD (excluding regular dialysis as a principal diagnosis) in 2017⁠–⁠18. Most of these (84%) had CKD as an additional (rather than principal) diagnosis.

The number of hospitalisations for CKD as the principal diagnosis (excluding regular dialysis) doubled between 2000⁠⁠–⁠⁠01 and 2017⁠–⁠18, from 24,100 to 51,300 hospitalisations. The age-standardised hospitalisation rate for CKD increased by 54% between 2000⁠–⁠01 and 2017⁠–⁠18 (126 and 194 per 100,000 population, respectively).

See Hospital care.

Kidney replacement therapy

In 2018, around 25,400 people received KRT. KRT rates are higher in males than females at all ages as ESKD is more prevalent in the male population. KRT rates increase with age until the age of 80 and then fall from age 80. Of all people receiving KRT, 53% had dialysis while 47% had a kidney transplant. The number of people receiving KRT has more than doubled in the last 2 decades, from around 10,500 to 25,400 and the KRT rate in 2018 (92 per 100,000) was 1.6 times as high as the rate in 1998 (57 per 100,000) (Figure 3).

This graph shows the increasing trend of persons with ESKD who are receiving KRT by sex from 1989 to 2018. The rates have more than doubled from 37 per 100,000 in 1989 to 92 per 100,000 in 2018 with rates consistently higher in males than in females. In 2018, the rate of persons with ESKD receiving KRT was approximately 1.6 times as high among males (115 per 100,000 population) than females (70 per 100,00 population).

Variation between population groups

The impact of CKD varies between population groups, with rates being 2.1–7.3 times as high among Aboriginal and Torres Strait Islander Australians compared with non-Indigenous Australians. Generally, the impact of CKD increases with rising socioeconomic disadvantage. Rates of CKD hospitalisation were 2.2 times as high in the lowest socioeconomic areas compared with the highest.

This table shows the relative impact of CKD in selected population groups in terms of rates of: prevalence, hospitalisation, death, incidence, receiving kidney replacement therapy and burden of disease. Rates for these measures were 2.1–7.3 times as high among Indigenous Australians as they were in non-Indigenous Australians. CKD rates were 1.9–3.7 times as high in Remote and very remote areas as they were in Major cities and the impact of CKD also increased with increasing socioeconomic disadvantage, with rates being 1.6–2.3 times as high in the most disadvantaged areas compared to the least disadvantaged ones.

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Where do I go for more information?

More information on CKD is available at:

Visit Chronic kidney disease for more on this topic.

References

ANZDATA (Australia and New Zealand Dialysis and Transplant Registry) 2018. ANZDATA Registry. Findings based on unit record analysis. Canberra: AIHW.

AIHW (Australian Institute of Health and Welfare) 2014. Cardiovascular disease, diabetes and chronic kidney disease—Australian facts: prevalence and incidence. Cardiovascular, diabetes and chronic kidney disease series no. 2. Cat. no. CDK. 2. Canberra: AIHW.

AIHW 2015a. Cardiovascular disease, diabetes and chronic kidney disease—Australian facts: Aboriginal and Torres Strait Islander people. Cardiovascular, diabetes and chronic kidney disease series no. 5. Cat. no. CDK 5. Canberra: AIHW.

AIHW 2015b. Linked ANZDATA, AIHW National Mortality Database, National Death Index. Findings based on unit record analysis. Canberra: AIHW.

AIHW 2016a. 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 no. 6. Cat. no. BOD 7. Canberra: AIHW.

AIHW 2016b. Incidence of end-stage kidney disease in Australia 1997–2013. Cat. no. PHE 211. Canberra: AIHW.

AIHW 2018. Chronic kidney disease prevalence among Australian adults over time. Cardiovascular, diabetes and chronic kidney disease series no. 6. Cat. no. CDK 6. Canberra: AIHW.

AIHW 2019a. Admitted patient care 2017–18. Cat. no. HSE 225. Canberra: AIHW.

AIHW 2019b. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015. Cat. no. BOD 22. Canberra: AIHW.

AIHW 2019c. National Hospital Morbidity Database. Findings based on unit record analysis. Canberra: AIHW.

AIHW 2019d. National Mortality Database. Findings based on unit record analysis. Canberra: AIHW.