Rising incident rates and poorer access to kidney transplantation among Aboriginal children and young adults in Australia

Aim: We aimed to describe the trends in incidence, aetiology, renal replacement therapy (RRT) modality and access to transplant among Aboriginal and Torres Strait Islander children and young adults (ACYA) residing in Australia. Background: Details of the paediatric end stage kidney disease population in Australia and New Zealand have been published previously. There is, however, paucity of studies exploring the trends in RRT modality and access to transplant among ACYA residing in Australia. Methods: Data on Australian patients who commenced RRT at ≤24 years of age from 1961-2017 was extracted from the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA). The incidence and prevalence rates were restricted from 1997 to 2017 due to unavailability of Aboriginal status specific census data prior to 1997.Results: A total of 3629 children and young adults received RRT during the observation period, including 178 (4.9%), who identified as ACYA and 3451(95.1%) other children and young adults (OCYA). Compared with OCYA, incident rates have risen among ACYA group since 2000 with the biggest rise for young adults aged 20-24 years. Fewer ACYA received a kidney transplant compared to OCYA cohort (56.2% versus 89.3%, p < 0.001). Only 6 (3.4%)ACYA received pre-emptive kidney transplant versus 580 (16.8%) OCYA(p < 0.001). Living related donor transplants were less common among ACYA than OCYA (10.7% versus 35.9%, p < 0.001).Conclusions: Our study shows rising incident rates and poorer access to kidney transplantation among ACYA in Australia. The reasons for this healthcare disparity and barriers to transplantation need to be explored further and require addressing.