Impending challenges of the burden of end‐stage kidney disease in Australia

Wai H Lim, David W Johnson, Stephen P McDonald, Carmel Hawley, Philip A Clayton, Matthew D Jose and Germaine Wong
Med J Aust 2019; 211 (8): . || doi: 10.5694/mja2.50354
Published online: 21 October 2019


  • Sex and age‐specific incidence rates of patients with treated end‐stage kidney disease (ESKD) in Australia are comparable to those in European countries, but substantially lower compared with those in the United States, Canada and many Asian countries.
  • The incidence rates of treated ESKD in Australia increase with advancing age; however, the incidence of ESKD is likely to be underestimated because a proportion of patients with ESKD (about 50%) remain untreated.
  • Late referral to nephrologists has reduced over the past decade, temporally associated with improved ESKD recognition. However, late referral still occurs in one in five Australians with ESKD.
  • One in two Australians with ESKD has diabetes, with up to 35% of cases directly attributed to diabetes.
  • Mortality rates for patients with ESKD remain substantially higher compared with the age‐matched general population, although there has been a significant improvement in survival over time.
  • Cardiovascular disease and cancer are the two most common causes of death in patients with ESKD.
  • Wai H Lim1
  • David W Johnson2,3
  • Stephen P McDonald4,5
  • Carmel Hawley2,3
  • Philip A Clayton4
  • Matthew D Jose6,7
  • Germaine Wong8

  • 1 Sir Charles Gairdner Hospital, Perth, WA
  • 2 Princess Alexandra Hospital, Brisbane, QLD
  • 3 Centre for Health Services Research, University of Queensland, Brisbane, QLD
  • 4 South Australian Health and Medical Research Institute, ANZDATA Registry, Adelaide, SA
  • 5 University of Adelaide, Adelaide, SA
  • 6 University of Tasmania, Hobart, TAS
  • 7 Royal Hobart Hospital, Hobart, TAS
  • 8 Westmead Hospital, Sydney, NSW



We acknowledge the substantial contributions of the Australian and New Zealand nephrology community (physicians, surgeons, database managers, nurses, renal operators and patients), which provides information to, and maintains, the ANZDATA database. The data reported here have been supplied by the ANZDATA registry, the UK Renal Registry, USRDS and CORR. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of any organisation. Wai Lim is supported by a Clinical Research Fellowship from the Raine Medical Research Foundation (University of Western Australia and Department of Health Western Australia) and by a Don and Lorraine Jacquot Career Development Fellowship (Royal Australasian College of Physicians). David Johnson is supported by a National Health and Medical Research Council (NHMRC) Practitioner Fellowship. Germaine Wong is supported by an NHMRC Career Development Fellowship. The ANZDATA Registry is funded by the Australian Organ and Tissue Authority, the New Zealand Ministry of Health and Kidney Health Australia.

Competing interests:

No relevant disclosures.


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