Charles Darwin University

CDU eSpace
Institutional Repository

 
CDU Staff and Student only
 

The incidence and outcomes of chronic kidney disease amongst Indigenous Australians

Lawton, Paul D. (2015). The incidence and outcomes of chronic kidney disease amongst Indigenous Australians. PhD Thesis, Charles Darwin University.

Document type: Thesis
Citation counts: Google Scholar Search Google Scholar
Attached Files (Some files may be inaccessible until you login with your CDU eSpace credentials)
Name Description MIMEType Size Downloads
Download this reading Thesis_CDU_60251_Lawton_P.pdf PDF version generated by student application/pdf 8.15MB 132
Reading the attached file works best in Firefox, Chrome and IE 9 or later.

Author Lawton, Paul D.
Title The incidence and outcomes of chronic kidney disease amongst Indigenous Australians
Institution Charles Darwin University
Publication Date 2015-11
Thesis Type PhD
Supervisor Cunningham, Joan
Subjects MEDICAL AND HEALTH SCIENCES
Abstract Over 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.


© copyright

Every reasonable effort has been made to ensure that permission has been obtained for items included in CDU eSpace. If you believe that your rights have been infringed by this repository, please contact digitisation@cdu.edu.au.

 
Versions
Version Filter Type
Access Statistics: 199 Abstract Views, 132 File Downloads  -  Detailed Statistics
Created: Mon, 20 Feb 2017, 11:45:48 CST by Jessie Ng