Dialysis hotspots identified on outskirts of capital cities

Dialysis

By Mardi Chapman

9 Jul 2024

Outer suburbs of capital cities and adjoining areas are the hotspots of demand for dialysis facilities, according to data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry.

The study, published in the Australian and New Zealand Journal of Public Health [link here], provides the evidence for planning future dialysis capacity but also identifies areas of need for prevention strategies and interventions to slow the progress of kidney disease.

The study captured data from 32,391 people receiving incident dialysis referenced to a capital city metropolitan Statistical Area Level 3 (SA3) for 2001-21.

It said growth in the number of dialysis consumers by SA3 varied widely across each of the metropolitan areas and was highest in Sydney SA3s.

“For example, Mount Druitt experienced annual incident growth from 9 people in 2001-03 to 32 in 2019-21, a 263% increase against background population gain of 21%. Respective values from Brimbank (Melbourne) were 17 to 46, 212%, against a background population gain of 22%.”

In Queensland, the incident hotspots were Caboolture, Ipswich and Forest Lake-Oxley to the north and west of Brisbane.

The study said the incident hotspots were frequently associated with high relative socioeconomic disadvantage and the largest cause of kidney failure in all cities was diabetic kidney disease (34.8% overall).

Using the higher-resolution Statistical Areas Level 2 (SA2), the study also found Western Sydney, outer Melbourne areas such as Brimbank, Darebin and Dandenong, and Brisbane-adjacent localities of Ipswich, Moreton Bay and Logan had the highest dialysis prevalence at the end of 2021.

“In each of the four largest cities, the three SA2s with the highest dialysis prevalence were also areas of high relative socioeconomic disadvantage, i.e. decile 1 or 2,” the study said.

The investigators said their study was the first in Australia to employ geo-referenced national registry data to describe incident hotspots of dialysis-treated kidney failure (KF).

“Enhanced by thematic mapping of demand, this approach has direct application to planning the optimal and equitable delivery of specialised and costly nephrology care for people with KF,” they said.

“Within the capital city incident hotspots, dialysis for DKD grew absolutely and relative to the whole dialysis cohort. A consumer population with increasing comorbidities and age will provide considerable challenges for service planning, which must address the greater complexity of need and cost of treatment.”

They noted that given the burden of lengthy and frequent haemodialysis treatments, the travel distance for patients to their treating unit limits access and adherence.

They also noted the opportunities the data provided for intervention.

“Progression from CKD to KF can be controlled by early detection in at-risk individuals and the implementation of best practices in management. Hotspots identified in metropolitan areas should be targeted for such interventions to improve early referral to specialist services and raise community awareness.”

They said their methodology could also be applied to other chronic diseases.

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