AN EPIDEMIC OF RENAL-FAILURE AMONG AUSTRALIAN ABORIGINALS

Objective: To define recent trends (1993-1996) in incidence of endstag e renal disease (ESRD) among Australian Aboriginal people in the Top E nd of the Northern Territory (NT). Design: Analysis of hospital and cl inical records of the Darwin-based ESRD treatment program from 1993 to 1996 and comparison with data accumulated since 1978. Participants: A ll people entering the ESRD treatment program from 1978 to 1996. Main outcome measures: Number of patients treated for ESRD; their ethnicity , age and sex; comorbidities in Aboriginal patients; treatment methods and outcomes. Results: More Aboriginal people presented with ESRD bet ween 1993 and 1996 (87) than in the previous 15 years of the program ( 68). The incidence of ESRD in Aboriginals reached 838 per million in 1 996, and is doubling every 4 years. Aboriginal people presenting with ESRD are younger than non-Aboriginal people with ESRD, and, in contras t to non-Aboriginals, ESRD rates are higher in women than men. The num bers and proportions of Aboriginal ESRD patients who have hypertension , type 2 diabetes and cardiac disease are rising. Haemodialysis remain s the most common form of treatment, and the number of dialysis treatm ents is doubling every 2.5 years. Only 9% of Aboriginal patients enter ing the program in 1993-1996 were treated with chronic ambulatory peri toneal dialysis and only 3% received transplants. Despite their younge r age, survival of Aboriginal people on dialysis is low (median 3.3 ye ars V. 6.5 years in non-Aboriginals), and graft survival after transpl ant is poor (37% at 5 years v. 88% in non-Aboriginals). Survival has n ot improved in the past 4 years, with fewer deaths from infection offs et by more deaths from cardiovascular disease. Conclusions: The predic ted doubling of ESRD incidence among Aboriginal people by the year 200 0 will add an enormous burden to limited resources. Risk factors for r enal disease underlie all the excess morbidity and mortality in NT Abo riginal adults, and arise out of accelerated lifestyle changes and soc ioeconomic disadvantage. Better living conditions and education, robus t and integrated primary healthcare programs, and systematic screening for early renal disease and treatment of those with established disea se are ail matters of urgency.