Hospitalisations for chronic kidney disease

In 2019–20, approximately 1.9 million hospitalisations (17% of all hospitalisations in Australia) recorded chronic kidney disease (CKD) as a principal and/or additional diagnosis.

Dialysis accounted for 81% of CKD hospitalisations in 2019–20. After excluding all hospitalisations where dialysis was recorded as the principal diagnosis, CKD hospitalisations accounted for 3.3% of all hospitalisations in Australia in 2019–20.

Hospitalisation data presented in this section are based on admitted patient episodes of care, including multiple events experienced by the same individual. Because individuals receiving dialysis are admitted for this purpose multiple times a week, hospitalisations involving dialysis as the principal diagnosis are not included in analyses of CKD hospitalisations, unless otherwise stated.

For more information, see Hospitalisations for dialysis.

After excluding hospitalisations where dialysis was the principal diagnosis, in 2019–20:

  • there were around 54,000 hospitalisations with CKD as a principal diagnosis – the diagnosis largely responsible for hospitalisation
  • there were around 319,000 hospitalisations with CKD as an additional diagnosis – a coexisting condition with the principal diagnosis or a condition arising during hospitalisation that affects patient management
  • on average, people hospitalised with a principal diagnosis of CKD (excluding dialysis as a principal diagnosis) stayed 2.4 days in hospital. For people who required hospitalisation for one night or more, the average length of stay was 3.5 days.

Dialysis was the leading cause of same-day hospitalisation in Australia in 2019–20, with around 1.5 million hospitalisations being for dialysis as a principal diagnosis (14% of all hospitalisations in Australia).

Besides dialysis, the most commonly recorded principal diagnosis for CKD in 2019–20 was ‘chronic kidney disease’, followed by ‘kidney tubulo-interstitial diseases’ (Table 1).

Table 1: Major causes of hospitalisation for chronic kidney disease (as the principal diagnosis), 2019–20
Major cause of hospitalisation Number
Chronic kidney disease 19,451
Kidney tubulo-interstitial diseases 14,542
Glomerular diseases 5,340
Other disorders of kidney and ureter 3,785
Complications related to dialysis and transplant 2,849
Hypertensive kidney disease 1,266
Diabetic nephropathy 1,178
Congenital malformations 1,021
Unspecified kidney failure 309
Dialysis (excluding preparatory care) 1,543,982
          Haemodialysis 1,537,436
          Peritoneal dialysis 6,546
Preparatory care for dialysis 4,358
Total 1,598,081

Source: AIHW National Hospital Morbidity Database.

Chronic kidney disease hospitalisations as a principal or additional diagnosis

When CKD affects patient care during hospitalisation – but is not the principal diagnosis – it is recorded as an additional diagnosis. Except where dialysis is the principal diagnosis, CKD is more often coded as an additional diagnosis.

The leading principal diagnoses in 2019–20 when CKD was listed as an additional diagnosis were:

  • heart failure: 20,200 hospitalisations (6.3%)
  • type 2 diabetes: 11,500 hospitalisations (3.6%)
  • sepsis (blood poisoning): 11,300 hospitalisations (3.5%)
  • acute kidney injury: 10,800 hospitalisations (3.4%)
  • pneumonia: 8,400 hospitalisations (2.6%).

CKD is often comorbid with cardiovascular disease and diabetes. In 2019–20, circulatory diseases were the most common type of principal diagnosis when CKD was an additional diagnosis, accounting for 18% (59,000) of these hospitalisations.

Injuries were also common principal diagnoses when CKD was an additional diagnosis (10.3% or 33,000 of these hospitalisations). Of these, complications associated with cardiac and vascular prosthetic devices, implants and grafts (5,800 hospitalisations) and fractures of the femur (5,100 hospitalisations) were the most common reasons for hospitalisation (Table 2).

CKD is associated with an increased risk of fractures, due to disturbances in mineral and bone metabolism as a result of the disease (Moe et al. 2006). Progression or development of kidney disease is also a risk associated with surgery, due to an increase in creatinine following surgery (Ishani et al. 2011).

Table 2: Leading principal diagnoses when chronic kidney disease was an additional diagnosis, by ICD-10-AM chapter and code, 2019–20
ICD-10-AM chapter Hospitalisations Percentage of hospitalisations where CKD was an additional diagnosis
Diseases of the circulatory system 59,007 18.5
Heart failure (I50) 20,177 6.3
Acute myocardial infarction (I21) 7,233 2.3
Cerebral infarction (I63) 3,886 1.2
Injury, poisoning and certain other consequences of external causes 32,754 10.3
Complications of cardiac and vascular prosthetic devices, implants and grafts (T82) 5,766 1.8
Fracture of femur (S72) 5,122 1.6
Complications of procedures, not elsewhere classified (T81) 1,702 0.5
Diseases of the respiratory system 28,619 9.0
Pneumonia (J18) 8,380 2.6
Chronic obstructive pulmonary disease (J44) 5,907 1.8
Unspecified acute lower respiratory infection (J22) 1,928 0.6
Diseases of the genitourinary system 26,410 8.3
Acute kidney injury (N17) 10,805 3.4
Other disorders of the urinary system (N39) 7,150 2.2
Obstructive and reflux uropathy (N13) 2,674 0.8
Endocrine, nutritional and metabolic diseases 25,221 7.9
Type 2 diabetes (E11) 11,456 3.6
Other disorders of fluid, electrolyte and acid-base balance (E87) 7,445 2.3
Type 1 diabetes (E10) 2,760 0.9

Note: Excludes chronic kidney disease as a principal diagnosis.
Source: AIHW analysis of the National Hospital Morbidity Database.

Variation by age and sex

In 2019–20, CKD hospitalisation rates (as a principal or additional diagnosis, excluding dialysis as a principal diagnosis):

  • were between 1.3 and 2.0 times higher for females than males before the age of 45. From age 45, rates were higher for men than women
  • increased with age, with 70% occurring in those aged 65 and over. CKD hospitalisation rates for males and females were highest in those aged 85 and over (18,400 and 10,900 per 100,000 population, respectively) – at least 1.6 times as high as those aged 75–84 (10,500 and 6,500 per 100,000, respectively) (Figure 1).

Figure 1: Chronic kidney disease hospitalisation rates, by diagnosis type, age and sex, 2019–20

The bar chart shows the rates of hospitalisation for chronic kidney disease by age groups and sex, with rates of hospitalisation increasing with age for males and females with people aged 85 and over having the highest rates (1.6 times higher than people aged 75 to 84 for principal and/or additional diagnoses of CKD).

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Variation between population groups

Aboriginal and Torres Strait Islander people

In 2019–20, there were around 29,400 hospitalisations for CKD as a principal or additional diagnosis among Indigenous Australians – around 3,400 hospitalisations per 100,000 population compared with 1,400 per 100,000 population among non‑Indigenous Australians.

  • Indigenous females were hospitalised for CKD at a higher rate than non-Indigenous females (around 4,000 compared with 1,200 per 100,000 population).
  • Indigenous males were hospitalised for CKD at a higher rate than non-Indigenous males (around 2,900 compared with 1,600 per 100,000 population).

After adjusting for differences in the age structure between the Indigenous and non-Indigenous populations:

  • The hospitalisation rate among Indigenous Australians was 5.3 times as high as the rate among non-Indigenous Australians.
  • The hospitalisation rate among Indigenous females was 6.9 times as high as the rate among non-Indigenous females, while the rate among Indigenous males was 4.0 times as high as the rate among non-Indigenous males (Figure 2).

Remoteness and socioeconomic area

In 2019–20, CKD hospitalisation rates (as the principal or additional diagnosis, excluding dialysis as a principal diagnosis) increased with remoteness and socioeconomic disadvantage.

After adjusting for differences in the age structure of the population groups, CKD hospitalisation rates were:

  • 2.9 times as high for people living in Remote and very remote areas as for people living in Major cities
  • 4.4 times as high among females living in Remote and very remote areas as for females living in Major cities
  • 2.0 times as high among males living in Remote and very remote areas as for males living in Major cities
  • more than twice as high for people living in the lowest socioeconomic areas compared with those living in the highest socioeconomic areas
  • 2.5 times as high among females living in the lowest socioeconomic areas as for females living in the highest socioeconomic areas
  • 2.0 times as high among males living in the lowest socioeconomic areas as for males living in the highest socioeconomic areas (Figure 2).

See Geographical variation in disease: diabetes, cardiovascular and chronic kidney disease for more information on CKD hospitalisations by state/territory, Population Health Network and Population Health Area.

Figure 2: Chronic kidney disease hospitalisation rates as a principal or additional diagnosis, by population group, 2019–20

The bar chart shows rates of hospitalisation for chronic kidney disease by sex based on Aboriginal and Torres Strait Islander status, remoteness area and socioeconomic area. Indigenous people had rates of hospitalisation for CKD 5.3 times higher than non-Indigenous people. Hospitalisation rates for CKD across remoteness areas were similar for all areas except Remote and Very remote regions, where people were hospitalised for CKD at rates 3.0 times as high as those living in Major cities. People living in the most disadvantaged socioeconomic areas were hospitalised at higher rates than all other areas, with rates decreasing with increasing socioeconomic advantage in the area which people lived. Males were hospitalised at higher rates than females across all measures except for Indigenous females and females living in Remote and Very remote areas.

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Trends for chronic kidney disease as a principal diagnosis

The number of hospitalisations for CKD as a principal diagnosis (excluding dialysis as a principal diagnosis) more than doubled between 2000–01 and 2019–20, from 24,200 to 54,100 hospitalisations. Over this period, the age-standardised rate rose by 54% (Figure 3).

Figure 3: Trends in chronic kidney disease hospitalisation rates as a principal diagnosis, by sex, 2000–01 to 2019–20

The line chart shows an increasing trend in age-standardised CKD hospitalisation rates between 2000-01 to 2019-20, when CKD was a principal diagnosis and a principal or additional diagnosis. Over this time, when CKD was a principal diagnosis, hospitalisations increased by 54%.

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Supplementary chronic condition codes

CKD (stages 3 to 5) can be recorded in hospitalisation data as a supplementary code, as opposed to a principal or additional diagnosis. Supplementary codes represent a selection of clinically important chronic conditions that are part of the patient’s current health status on admission which do not meet criteria for inclusion as additional diagnoses but may affect clinical care.

  • CKD (stages 3 to 5) was the ninth most-assigned supplementary code for hospitalisations in 2019–20, assigned in 1.8% of hospital admissions.
  • Since the supplementary code for CKD was introduced in 2015–16, the number of hospitalisations recording CKD as an additional diagnosis has fallen.