Kidney Failure due to Diabetic Kidney Disease Among Australians Aged ≤ 45 Years, 2000-2022: A Population-Based Geospatial Analysis.

Abstract

Aim: Evaluate the area-level incidence of kidney failure due to diabetes among Australians aged ≤ 45 years.

Methods: Using Australian registry and census data (2000-2022), incidence rates and prevalence of kidney failure (defined as commencing kidney replacement therapy) due to diabetes among people aged ≤ 45 years were compared by geographical region.

Results: Incidence (per 100 000/year, 95% confidence interval) of kidney failure due to diabetes among people aged ≤ 45 years in Australia was 0.72 (0.68-0.77) in 2000-2011, and 1.13 (1.07-1.18) in 2012-2022 (incidence rate ratio [IRR] 1.56, 1.50-1.62). Between 2012 and 2022, there were 48 regions where the crude incidence of kidney failure due to diabetes was more than double the national average, the highest being 49.8 cases per 100 000 per year. Between 2012 and 2022, all jurisdictions had similar age-sex-adjusted point estimates for kidney failure incidence (range 0.78-1.48) except for the Northern Territory (15.8, 13.9-17.8). The most significant characteristics associated with the rate of incident kidney failure were residence in remote areas (IRR 13.9, 13.1-14.8, ref. major cities), socioeconomic disadvantage (IRR 2.96, 2.75-3.19, ref. advantaged areas), and Aboriginal and Torres Strait Islander ethnicity (IRR 24.2, 23.0-25.5). Between the eras, people born outside Australia had the largest increase in incident cases (IRR 2.47, 2.23-2.72) but had a lower overall incidence than those born in Australia (IRR 0.55, 0.52-0.59).

Conclusion: In Australia, there was an increase in the incidence of kidney failure due to diabetes among people aged ≤ 45 years in the last two decades. There was a strong relationship between the risk of kidney failure and social determinants of health, including place of residence, socioeconomic status and Indigenous status.