Historical and Contemporary Burden of ESKD among Torres Strait Islander People of Australia, 1963-2022

Background: Zenadh (Torres Strait Islander) people are the First Peoples of the lands and waterways of the Torres Strait in Australia. Zenadh people have been oppressed by colonisation and systemic racism for many years, experiencing sustained barriers to healthcare and optimal health outcomes. Today, Zenadh people live with inequitable rates of advanced diabetes and kidney disease. To best advocate for health equity change, Tribal Elders sought to describe the patterns, modality, and outcomes of kidney replacement therapy (KRT) among Zenadh people to inform health-improving actions. Methods: Data was extracted from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry that included demographic details (age, sex, location), primary disease, comorbidities, and treatment modality. Adults (≥18 years) who commenced KRT in Australia between 1963 and 2022 were included, and we describe patients with the ethnicity identifier of "Torres Strait Islander". The research and its conduct was approval by Maluilgal Tribal Governance and an Indigenous Health Ethics Committee. Results: A total of 453 Zenadh adults received KRT during 1963-2022, with an average commencement age of 54 (SD=12.3) years and 55% were female. The most recent decade accounted for 42% (190/453) of KRT initiation, and the majority of patients overall were resident of Queensland (92%, 418/453). Diabetic kidney disease was the primary kidney disease in most patients (75%, 341/453). Forty-seven (10%) transplants occurred since 1978. For Zenadh patients still alive at 31 December 2022, satellite and hospital haemodialysis were the two most common KRT modalities (51% and 26%, respectively), and transplantation was 9%. Conclusion: This analysis presents, for the first time, data specific to the treatment of kidney failure for Zenadh people who have lived across Australia during 1963-2022. This first look into the historical and contemporary burden of kidney disease establishes baseline health statistics from which health improving actions can be progressed and health systems held accountable for equity and change.