End-stage kidney disease (ESKD), the most severe form of chronic kidney disease, results in a high health and economic burden for patients, families and communities. It usually requires kidney replacement therapy (KRT) in the form of dialysis or kidney transplantation for patients to survive. The number of people receiving KRT treatment for ESKD has tripled between 1991 and 2011.
This report examines whether the number of people with treated-ESKD (prevalence) will continue to increase up until 2020. This information is important for health service planning and resource allocation in the future. It is important to note that projections are not intended to function as exact forecasts, but to give an indication of what might be expected if the stated assumptions were to apply over the projection time frame and so should be interpreted with this in mind.
The projected treated-ESKD prevalence estimates were derived from a series of models, to provide a range of projection results. The report also examines the influence of diabetes on future treated-ESKD prevalence growth.
Prevalence of treated-ESKD is increasing
- The number of people receiving KRT for their ESKD is projected to increase over the next decade. The 'base' model predicts that the prevalence will rise by 60%-from 19,780 cases in 2011 to 31,589 cases in 2020. This is despite the Australian population only increasing 13% over this period (ABS 2013a).
- The projected increase in treated-ESKD is expected to occur across all age groups, with the largest increase occurring for people who start treatment when they are over 75, where the prevalence is projected to double from 2,013 to 4,130 cases.
- When the rate of new cases of treated-ESKD is held constant, the prevalence of treated- ESKD is projected to increase by 45% (rising to 28,756 cases). Where dialysis survival is expected to improve over the projections years, the prevalence is expected to increase by 64% (rising to 32,437 cases).
Diabetes to continue to contribute to increases in treated-ESKD
- The prevalence of treated-ESKD with diabetes as a primary cause is projected to double between 2011 and 2020 (from 4,392 to 9,677 cases). By contrast, the prevalence of treated- ESKD without diabetes as the primary cause is projected to increase by 47% (from 15,388 to 22,960 cases).
Dialysis- and transplant-treated-ESKD cases are projected to increase
- The number of dialysis-treated ESKD patients is projected to increase by 49%-from 10,998 cases in 2011 to 16,362 cases in 2020, while the number of transplant-treated patients is projected to rise by 73%-from 8,782 cases in 2011 to 15,227 cases in 2020.
- In 2020, almost half (48%) of all treated-ESKD patients are predicted to have a functioning kidney transplant. This compares with 44% in 2011.
Preliminary material: Acknowledgments
- Data sources
- Construction of 'base' prevalence projections model
- Projection assumptions
- Variables controlled for in 'base' prevalence projections model
- Data limitations
- Alternative models
3 Base prevalence projections model
- Kidney replacement therapy (KRT) treatment trends
- Influence of diabetes
4 Alternative models
- 'Stable incidence' model
- 'Improving dialysis treatment outcomes' model
- Implications of projections
- The issue of untreated-ESKD
- Future projections work
Appendix A: Treatment options for end-stage kidney disease (ESKD)
Appendix B - Statistical methods
Appendix C - Model accuracy
Appendix D - Alternative models
Appendix E - Detailed data
End matter: Glossary; References; List of tables; List of figures