Profiles and outcomes of indigenous patients with chronic kidney disease in renal speciality clinics in the public health system in Queensland, Australia

Abstract Background High rates of chronic kidney disease (CKD) are well recognised in Australia’s Indigenous people, but kidney replacement therapy (KRT) registrations give an incomplete view of disease burden and outcomes. We describe profiles and outcomes of Indigenous people with preterminal CKD in the renal specialty practices of the public health system in the state of Queensland, through a prospective cohort study. Methods Adults patients with non-dialysis CKD from twelve public renal speciality services in Queensland were recruited to the CKD QLD Registry and followed until the start of KRT, renal death without KRT, or nonrenal death, or until the censor date of June 2020. Information on demographic and clinical features, hospital admissions and outcomes was compiled from data collected by Queensland Health. Results 7,595 CKD patients were enrolled. 641 (8.4%) were Indigenous, more than twice their proportion in Queensland’s population They lived more remotely than non-Indigenous patients, were more disadvantaged, were younger, more often female and more often had diabetes and had 35.3% greater hospital costs. They were 50% more likely to develop end stage kidney failure (ESKF), and when they did, more than twice as likely as nonIndigenous patients to start KRT, a function of their younger age. Notably, however, half of the Indigenous and 72% of the non-Indigenous patients with endpoints did not start KRT. The estimated 4.7-fold increase in incident KRT in Indigenous patients aligns well with official statistics. Conclusions Routinely collected service data reveal a more expansive view of CKD and its outcomes in Indigenous patients under renal specialty care in Queensland. Such surveillance can inform health services planning for CKD patients beyond expectations of KRT needs and can underpin ongoing evaluations.