Abstract
BackgroundThe Northern Territory of Australia has a very high incidence of treated end-stage kidney disease (ESKD), largely confined to Indigenous Australians living in remote, under-resourced areas. Surveillance of chronic kidney disease (CKD) is still in its infancy in Australia. We estimate the prevalence and rate of progression of measured CKD across a region using inexpensive readily available laboratory information.MethodsUsing a retrospective de-identified extraction of all records with a serum creatinine or urinary albumin-to-creatinine ratio from the single largest ambulatory pathology provider to the Top End of the Northern Territory of Australia between 1st February 2002 and 31st December 2011, the yearly total and age-specific prevalence of measured microalbuminuria, overt albuminuria and estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2, and the prevalence of progressive CKD, were calculated.ResultsThere was a steady increase in the proportion tested across all health districts in the region, more prominent in non-urban districts. In 2009, the regional adult prevalence of measured microalbuminuria and overt albuminuria was as high as 8.1 %, overt albuminuria alone up to 3.0 % and eGFR < 60 up to 2.3 %. Rates of progressive disease were extremely high, particularly for those with albuminuria (53.1–100 % for those with urinary albumin-creatinine ratio > 300 mg/mmol).ConclusionsThe rates of testing, particularly in districts of high measured prevalence of markers of CKD, are encouraging. However, extremely high rates of progressive CKD are troubling. Further describing the outcomes of CKD in this population would require analysis of linked datasets.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-015-0166-6) contains supplementary material, which is available to authorized users.
Highlights
The Northern Territory of Australia has a very high incidence of treated end-stage kidney disease (ESKD), largely confined to Indigenous Australians living in remote, under-resourced areas
For the time of this study the Top End region of the Northern Territory (NT) was served by one dominant provider of ambulatory pathology services, Western Diagnostic Pathology (WDP, Myaree, Western Australia, a private laboratory providing pathology services across the NT and WA); almost all services for dialysis and transplant patients were provided through an alternative, NT Department of Health hospitals pathology
Over most of the period, there was an increase in the number of people being tested with either a serum creatinine or urinary albumin-to-creatinine ratio (UACR); this was consistently weighted towards the major population centre, the Darwin Urban district
Summary
The Northern Territory of Australia has a very high incidence of treated end-stage kidney disease (ESKD), largely confined to Indigenous Australians living in remote, under-resourced areas. A few studies have examined clinical laboratory results to determine the prevalence of measured CKD across regions [12, 13], including one in the Australian state of Tasmania [14] While this method cannot take the place of a population-based random sample, it can be an important adjunct if the population is hard to reach due to remoteness, health service limitations or cross-cultural and linguistic challenges. For the time of this study the Top End region of the NT was served by one dominant provider of ambulatory pathology services, Western Diagnostic Pathology (WDP, Myaree, Western Australia, a private laboratory providing pathology services across the NT and WA); almost all services for dialysis and transplant patients were provided through an alternative, NT Department of Health hospitals pathology This allowed calculation of the prevalence of measured CKD that largely excluded those with treated ESKD without the need for data linkage, which has particular ethical and technical challenges for Indigenous Australians [15] and is time consuming, expensive and still in a capacitybuilding phase in Australia
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