AbstractOver the last thirty years an end-stage kidney disease (ESKD) epidemic has occurred amongst Aboriginal and Torres Strait Islander (Indigenous) Australians. This thesis uses existing data to examine the outcomes of Indigenous ESKD patients receiving renal replacement therapy (RRT), and in more detail the outcomes of both treated ESKD and chronic kidney disease (CKD) in the Northern Territory (NT) of Australia (whose Indigenous peoples have especially high rates of kidney disease).
Using national RRT registry data, unadjusted analysis suggested that past differences in survival between Indigenous and non Indigenous Australians had closed more recently. However, adjusting for substantial population differences uncovered significant persisting disparities in survival despite improvements overall. Analysis limited to dialysis patients aged 15–64 years showed that survival differences between Indigenous and non-Indigenous patients have improved over time, but that Indigenous transplant rates have worsened. Analysis comparing transplant recipients to similar dialysis-only patients (using propensity score methods) revealed that Indigenous transplanted patients had better survival than similar dialysis-only patients but relatively fewer suitable Indigenous patients were transplanted.
Linked NT hospital and RRT registry data revealed large variations in haemodialysis treatment attendance. Lower attendance was associated with being Indigenous (rather than relocation from remote areas), and with higher rates of death and hospitalisation and much lower rates of transplantation.
Ambulatory laboratory data from the main pathology service for the Top End of the NT were examined. Rates of testing were high and rising, particularly in remote districts with high CKD prevalence. Among those with albuminuria, extremely high rates of progressive CKD were found.
Taken together these findings suggest that current Indigenous/non- Indigenous disparities in ESKD outcomes are attributable to low transplantation rates and lower treatment attendance. High rates of CKD progression in remote areas are also concerning. These findings raise questions about the quality and equity of care for Indigenous patients. Further analysis requires linked datasets.
|Date of Award
|Joan Cunningham (Supervisor) & Yuejen Zhao (Supervisor)