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Renal disease in Indigenous populations

Dunya Tomic, Chief of Editorials and Publications PMSA


End-stage renal disease (ESRD) has been identified as a major issue across Indigenous Australians (1) as well as Maori and Pacific Islander populations in New Zealand (2). There has been extensive research into the aetiology and pathogenesis of kidney disease amongst Indigenous Australians, particularly for glomerular disease, which is well-documented in the literature (3). However, there is a scarcity of data regarding the burden of individual kidney diseases in any of these three groups, or any comparison to other populations.

One major paper published in 2004 (4) aimed to produce incidence rates of ESRD, standardised for age and sex, across Australia and New Zealand, separating populations into Indigenous and non-Indigenous for Australians, and Maori, Pacific Islander and all other New Zealander groups. Data was collected from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA)(5) between the years 1992-2001 for four groups comprising children, young adults, middle-aged adults and the elderly. These average annual incidence rates were then compared to the global population (6).

In the data recorded for New Zealander patients, Pacific Islanders mainly comprised Samoans, Cook Islanders and Tongans. For Australians, Indigenous patients were overwhelmingly Aboriginal (94%) with the remainder identifying themselves as Torres Strait Islanders. Of non-Indigenous patients across both Australia and New Zealand, the vast majority were European with smaller proportions being Asian.

Incidence rates amongst children were found to be similar across all demographic groups. However, in all other age categories, there were significant differences across the populations defined above. In general, Indigenous Australians had the highest rates of all-cause ESRF. Maori and Pacific Islander populations had moderate levels of disease, whereas non-Indigenous groups had unremarkable results. Of note, in the young adult and middle-aged groups, Indigenous Australians, Maori and Pacific Islanders had rates of disease up to ten times of those in non-Indigenous and ‘other’ groups. In addition, Indigenous Australians had higher incidence of disease resultant from type II diabetic nephropathy, hypertensive renal disease, analgesic nephropathy and glomerulonephritis.

In conclusion, the high burden of type II diabetes (7) and hypertension (8) amongst Indigenous Australians, Maori and Pacific Islander populations make them particularly susceptible to ESRF. However, the substantial ESRF burden seen amongst these groups cannot be attributed to these diseases alone. Unhealthy lifestyles, impacts of Westernisation and adverse intrauterine exposures all contribute to this burden of disease from an upstream perspective (9). Therefore, it is important that future strategies to reduce the incidence of ESRF, which is evidently significant enough to warrant intervention, should focus on health promotion strategies targeted at these particular groups.


References

  1. Cass A, Cunningham J, Snelling P, Wang Z, Hoy W. Exploring the pathways leading from disadvantage to end-stage renal disease for Indigenous Australians. Sos Sci Med. 2004;58:767-785.

  2. New Zealand Glomerulonephritis Study Group. The New Zealand Glomerulonephritis Study: introductory report. Clin Nephrol. 1989;31:239-246.

  3. Hoy WE, Mathews JD, McCredie D, et al. The multidimensional nature of renal disease: rates and associations of albuminuria in an Australian Aboriginal community. Kidney Int. 1998;54:1296-1304

  4. Stewart JH, McCredie MR, McDonald SP. The incidence of treated end-stage renal disease in New Zealand Maori and Pacific Island people and in Indigenous Australians. Nephrol Dial Transplant. 2004;19(3):678-685.

  5. Maisonneuve P, Agodoa L, Gellert R, et al. Distribution of primary renal diseases leading to end-stage renal failure in the United States, Europe, and Australia/New Zealand: results from an international comparative study. Am J Kidney Dis. 2000;35:157-165.

  6. Dos Santos Silva I. Cancer epidemiology: principles and methods. International Agency for Research on Cancer, Lyon, 1999;57-82.

  7. Scragg R, Baker J, Metcalfe P, Dryson E. Prevalence of diabetes mellitus and impaired glucose tolerance in a New Zealand multiracial workforce. NZ Med J. 1991;104:395-397.

  8. Abbott P, Close G. Vascular health risks in the Aboriginal community – a cultural approach. Aust Family Physician. 2002;31:605-610.

  9. White AV, Hoy WE, McCredie D. Childhood post-streptococcal glomerulonephritis as a risk factor for chronic renal disease in later life. Med J Aust. 2001;174:492-496.

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