Rapid progression of chronic kidney disease in five years prior to haemodialysis initiation in Central Australia

The Northern Territory has the highest Australian incidence rate per population of haemodialysis (HD)-dependent chronic kidney disease (CKD). Our aim was to describe the average annual estimated glomerular filtration rate (EGFR) decline in the previous five years for adults commencing HD in Central Australia in 2012. No patients were started on peritoneal dialysis in Central Australia in this period. Central Australian clinical databases were retrospectively audited for serum creatinine (sCR), albuminuria (ACR), glycated Hb (HbA1c), and EGFR for the five years preceding HD-start. All results were included for the audit duration (from the earliest date for five years (audit entry, AE) prior to HD-start); an average annual EGFR decline was calculated using the CKD epidemiology collaborative (CKD-EPI) equation. Fortynine clients initiated HD in 2012 (96% Indigenous, 65% female, age 45 years, diabetes primary renal disease 80%). The median (IQR) audit duration was 3.8 (2.5, 4.6) years. At audit-entry, the mean ACR and EGFR were 157 mg/mmol and 51 ml/min/1.73m2 respectively, corresponding to 91% clients having macroalbuminuria (ACR >30 mg/mmol), and 15% having an EGFR <30 ml/min/1.73m2. The average annual EGFR decline was 14 ml/min/1.73m2. We observed rapid CKD progression in Central Australian clients commencing HD in 2012, and related to macroalbuminuria with moderately impaired EGFR at audit entry. Slowing CKD progression in this region requires adequately supported clinical systems identifying and tracking clients with high CKD risk.