Chronic kidney disease

Chronic kidney disease is a debilitating chronic disease in its own right, but can also contribute to, or be impacted by, other prominent chronic diseases, including cardiovascular disease and diabetes mellitus.

Page last updated: 24 November 2016

What is chronic kidney disease?

Chronic kidney disease (CKD) refers to all conditions of the kidney, lasting at least 3 months, where a person has had evidence of kidney damage and/or reduced kidney function, regardless of the specific diagnosis of disease or condition causing the disease. Evidence of kidney damage manifests as either urinary protein or albumin (a type of protein that is a more sensitive and specific marker of kidney disease), blood in the urine, or scarring detected by imaging tests.

CKD is categorised into 5 stages according to the level of reduced kidney function and evidence of kidney damage. Stages of CKD are measured by the glomerular filtration rate, which is the amount of blood the kidneys clear of waste products in one minute. Because this rate cannot easily be measured directly, current practice is to estimate it by applying a formula based on age, gender and creatinine (a breakdown product of a molecule found in muscle that is important for energy storage) in the blood. An individual can move up and down through the first four stages of severity, but once they reach stage 5, their kidney function does not usually improve.

In severe cases, kidney function may deteriorate to the extent that it is no longer sufficient to sustain life and, if untreated, will most likely cause death. This is called End-stage kidney disease (ESKD) and those affected by this disease require kidney replacement therapy - either dialysis or kidney transplant - to survive. Top of page

How common is chronic kidney disease?

CKD can often lack symptoms in its early stages so the diagnosis of kidney disease is often delayed or missed, which makes it difficult to accurately gauge the number of persons affected by the disease. Some estimates indicate, however, that
  • In 2014-15, 203,400 Australians, or 0.9% of the population, reported having kidney disease, with similar rates for men and women. (source 1).
  • Only 1% of this 10% cohort returned test results indicating stage 4 or 5 kidney damage, which are the levels at which an individual becomes at risk of their condition progression to ESKD (source 1).
  • CKD is overrepresented amongst Aboriginal and Torres Strait Islander persons, with 3.1% of aged 15 years and over (more than triple the rate for the non-indigenous population) estimated to have some form of CKD from self-reporting in 2014-15. (source 2).
  • In 2014, there were 22,234 Australians received kidney replacement therapy for ESKD, including 10,143 who had a functioning kidney transplant and 12,091 who were receiving dialysis. (source 3). Males account for around 60% of all ESKD cases, and of all the cases of the disease that arose in Australia between 2002 and 2012, almost 63% involved persons aged 70 years and over (source 4). Top of page

What are the risk factors for chronic kidney disease?

CKD closely co-exists with cardiovascular disease and type 2 diabetes, with these three diseases accounting for around a quarter of the entire disease burden in Australia. Accordingly, CKD shares a number of common risk factors with these other chronic diseases, including: overweight and obesity, physical inactivity, poor diet, tobacco smoking, high blood pressure (hypertension), and low birth weight.

Major risk factors associated with CKD that cannot be modified include advancing age, genetic predisposition, previous kidney disease or injury, low birth weight, male gender, and family history. Top of page

Treatment or management of chronic kidney disease

Early CKD is usually asymptomatic and must be actively sought to be recognised. Kidney function is measured by the glomerular filtration rate (GFR), which is the amount of blood the kidneys clear of waste products in one minute. As GFR cannot be measured directly, current practice is to estimate GFR (eGFR) by applying a formula that includes age, gender and creatinine levels in the blood. Kidney function can also be tested by measuring the levels of albuminuria (type of protein) in the urine, but this testing requires follow-up, as CKD is diagnosed where albuminuria is seen to be persistent in the urine for at least three months.

General practitioners (GPs) are the usual source of initial assessment and diagnosis of CKD and have a variety of options available for treating the condition, including the ordering of imaging and pathology tests, prescribing of medications and, where necessary, referral to a specialist. Best practice management of CKD utilises a collaborative effort, involving at least the individual and their GP, but also including practice nurses and/or allied health professionals as appropriate.

Referral to a nephrologist will commonly occur in situations where an individual reaches stage 4 CKD, or when an individual presents to a GP displaying acute conditions associated with kidney disease.

In situations where an individual’s kidney condition deteriorates to the point where existing function cannot sustain life, they will require kidney replacement therapy (KRT), which involves either renal dialysis (haemodialysis or peritoneal) or kidney transplantation. Haemodialysis involves the diverting of the blood from the body to a dialysis machine, where it is subsequently filtered and returned to the body. This type of dialysis can be conducted at home, in the hospital or in a satellite clinic, although where performed in the home, the patient will commonly require assistance with connecting to the dialysis machine. With peritoneal dialysis, the abdomen is filled with sterile dialysis solution and the blood is filtered through the peritoneal membrane (which covers the abdominal cavity organs such as the stomach, liver and intestines). The patient does not need to be in a hospital or clinic, and can usually manage the procedure without assistance. Top of page

Chronic kidney disease programs and initiatives

CKD is addressed at a national level through a range of programs and initiatives to support treatment and management of renal-related problems. Significant funding is also provided to ensure that quality clinical research is conducted into kidney disease, and to maintain national monitoring and surveillance measures.

Programs that support management and treatment of kidney disease conditions include:
  • The Medicare Benefits Schedule, which provides subsidies for patient care and includes Medicare items for the planning and management of chronic and terminal conditions. Eligible patients can also be referred by a GP for up to five Medicare subsidised allied health services that are directly related to the treatment of their chronic condition, including CKD.
  • The Pharmaceutical Benefits Scheme continues to provide subsidies for medicines used in the treatment of kidney and renal conditions.
  • Significant investments in arthritis research through the National Health and Medical Research Council (NHMRC) for research into kidney and renal conditions. Improving the care of patients with multiple and complex chronic disease, including CKD, has also been identified by the NHMRC as a major focus in its 2013-15 Strategic Plan.
Additionally, the Australian Institute of Health and Welfare (AIHW) is funded to support national surveillance and monitoring of vascular diseases, which includes CKD, along with diabetes and cardiovascular disease.

Funding is also provided to support organ donation (kidneys are the most commonly donated organ) by reducing the financial stress associated with living organ donation by providing a contribution to paid leave. Under this scheme, assistance is paid to a donor at up to the National Minimum Wage for up to six weeks.

State and territory governments are responsible for renal dialysis services. Top of page

Related links

Sources

1 Australian Bureau of Statistics 2015. 4364.0.55.001 - National Health Survey: First Results, 2014-15. Viewed 25 July 2016.
2 Australian Bureau of Statistics 2016. 4714.0 - National Aboriginal and Torres Strait Islander Social Survey, 2014-15. Viewed: 25 July 2016.
ANZDATA (Australian and New Zealand Dialysis and Transplant) 2015. ANZDATA Registry report 2014. Adelaide: Australian and New Zealand Dialysis and Transplant Registry, p.xxii.
4 Australian Institute of Health and Welfare 2014. Cardiovascular disease, diabetes and chronic kidney disease – Australian facts: Prevalence and incidence. Cardiovascular, diabetes and chronic kidney disease series no. 2. Cat. no. CDK 2. Canberra:AIHW, pp.74 & 76.

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