Kidney disease among Aboriginal people
When kidneys fail Aboriginal people are more likely to get dialysis treatment than a transplant.
- Times an Aboriginal person is more likely to have kidney disease . In some remote communities this can be 30..50 times the national average [7,8].
- Times an Aboriginal person is more likely to die from kidney disease .
- Proportion of Aboriginal kidney failure sufferers living in regions without any dialysis facilities .
- Survival rate in years for people with renal failure .
Nephritis is inflammation of the nephrons in the kidneys. Nephritis is usually associated with poverty. Outbreaks in Australia mainly occur in remote Aboriginal communities in far northern Australia and affect young children.
Kidney problems and failure is frequent among older Aboriginal people. A prominent victim of the disease is Yothu Yindi lead singer M Yunupingu who died in May 2013.
Older Aboriginal Australians (40 to 60 years old) are more than 15 times more likely to die of kidney disease than non-Aboriginal Australians .
The population structure in Aboriginal Australia is quite different to the non-Aboriginal population and is more like a pyramid, with many more children than adults and even fewer living grandparents. This means that an Aboriginal child receives support and guidance from far fewer adults.
This pyramid-like structure is generated partly by early death of Aboriginal adults from heart disease, diabetes and kidney disease.
Smoking, diabetes, poor nutrition, obesity and lack of exercise are among the causes of kidney failure.
Mothers with kidney damage can pass on the disease to their children. Aboriginal mothers often have evidence of kidney disease already present during pregnancy and Aboriginal babies are frequently born with a much smaller number of nephrons (the functional units of the kidney). While non-Aboriginal babies have over one million, Aboriginal babies have typically around 400,000 . As a result, Aboriginal babies are born too small.
Health professionals distinguish between chronic kidney disease (CKD) and end-stage kidney disease (ESKD), a stage when people need either dialysis or a transplant to survive. Kidney failure is also known as renal failure, and ESRD (end-stage renal disease).
Almost 10% of ESKD patients treated in 2007-2008 were Aboriginal or Torres Strait Islander people .
But 9 out of 10 cases could be avoided if Aboriginal people were treated at the same rate as non-Aboriginal people.
In 2008-09, 11 times more Aboriginal people went to hospital for dialysis treatment than non-Aboriginal people . Attendance rates for treatment are poor because it is not easy to let Aboriginal people feel at ease in western hospitals.
The plan is not to have a plan
Don Palmer is CEO of the Malpa Project which aims to close the gap in Aboriginal health. He remembers learning about the government’s plan in helping lessen Aboriginal kidney failure .
“Some years ago I had the sobering pleasure of travelling around Indigenous communities with Jimmy Little for about three years whilst helping to set up his foundation.
Once when we were travelling together in Alice Springs I met the Northern Territory Health Minister [and] asked what his plans were for addressing the extraordinary incidence of kidney failure.
Kidney failure runs at about 30-50 times the national average out in the Centre.
He said he had no plan.
I mentioned this to Jimmy over breakfast the next day and he said the only hard thing I ever heard him say.
He began with ‘There is a plan’. What is it I asked, eagerly. His reply lives with me.
He said ‘The plan is not to have a plan’.”
Aboriginal to non-Aboriginal ratios of ESKD Instead of moving permanently to the next town and living full-time in the disconcerting environment of a western town Aboriginal people can now visit more culturally appropriate stations, staying closer to their family and the community. Photo: Renee Nowytarger, The Australian 
At Kintore community in the deep desert, where the experts said dialysis would never work, the band of kidney patients trained in the purple [dialysis] house have a perfect 100% turn-up rate.—The Australian 
Painting for relief
In the early 1990s the Pintubi people of the Western Desert area tried to get government support for dialysis, but without success.
They formed the Western Desert Dialysis Appeal, and community members painted pictures and sold them through the Art Gallery of NSW, raising $1 million.
With the money raised they set up dialysis machines in Alice Springs and Kintore in 2004, with Kintore having the first dialysis machine in a remote community in Central Australia .
Aboriginal communities use mining royalties, self-funding and philanthropic support to finance dialysis services .
Only 12% of Aboriginal Australians with treated ESKD have a functioning kidney transplant, compared with 45% of non-Aboriginal Australians . Kidney transplantation usually gives the best rehabilitation at the lowest cost , but because there are not enough donors it is used less than dialysis, the next best option. Hence Aboriginal people are more likely to be on dialysis than to receive a kidney transplant . Matching genetics is another challenge.
Patients suffering from kidney disease are not only traumatised because of the illness, but also when they have to relocate vast distances from their homeland to receive life-saving treatment . “It is just not practical or financially possible for people to get back home, many patients have not been able to return home for many years,” says Jimmy Little, founder of the Jimmy Little Foundation which aims at helping Aboriginal sufferers .
For this reason, the Jimmy Little Foundation offers a Return To Country program. Patients need to receive dialysis three times a week, with each treatment lasting 4 to 5 hours.
Dialysis can be delivered into remote Aboriginal communities but requires cultural training of staff who need to learn to use photographic rather than written instructions, and show respect and avoid naming deceased persons after family deaths.
Aboriginal to non-Aboriginal ratios of ESKD for male Aboriginal people . The ratio is particularly high in the Northern Territory.
Last updated: 14 June 2013 | Out of respect for Aboriginal culture I use Indigenous sources as much as possible.
 'New kidney illness fears', Koori Mail 510 p.3
 'Kidney disease in Australian Aboriginals: time for decisive action', Medical Journal of Australia 1998; 168: 532-533, www.mja.com.au/public/issues/jun1/thomas/thomas.html, retrieved 18/11/2011
 'Review of Indigenous male health', Australian Indigenous Health Info Net, www.healthinfonet.ecu.edu.au/population-groups/men/reviews/our-review, retrieved 18/11/2011
 'Purple house gives Bonita a new lease on life', The Australian, 22/1/2007, www.theaustralian.com.au/news/purple-house-gives-bonita-a-new-lease-on-life/story-e6frg6po-1111112868595, retrieved 18/11/2011
 'Jimmy takes kidney message to Woodford', Koori Mail 419 p.57
 'Returning to country', Koori Mail 399 p.57
 'Picture of health', Deadly Vibe magazine, May 2011 p.23
 'Not bleeding hearts, just the bleeding obvious', Don Palmer, inaugural Sydney University Red Cross Society Lecture, 16/8/2011
 'Kidney disease in Aboriginal Australians perpetuates poverty', The Conversation 10/6/2013