1Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia, 2Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia, 3Central Northern Adelaide Renal and Transplantation Services, Royal Adelaide Hospital, Adelaide, Australia

Aim: To describe the spatio-temporal variation of the incidence of kidney replacement therapy (KRT) in Australia’s two largest metropolitan areas and determine emerging hotspots of incidence.
Background: Kidney replacement therapy incidence has been well described clinically but less so with regard to spatial and spatio-temporal variation. Such analyses have the potential to offer insights into disease patterns and service demand.
Methods: Patients beginning KRT in each year 1998-2018 in Australia’s larger metropolitan areas were enumerated from the ANZDATA Registry. Incidence rates were determined for each ABS Statistical Area Level 3 (SA3) on the basis of each patient’s residential postcode at first dialysis or pre-emptive transplant. Cluster analysis using Getis-Ord Gi* and space-time cube analysis were used to determine clusters of high incidence cross-sectionally and emerging hotspots. Hotspots were compared with the distribution of underlying risk factors including the Index of Relative Socioeconomic Disadvantage (IRSD).
Results: Three-yearly incidence rates per SA3 ranged from 13.0 [95% CI 0.3-72.2] per million per year to 262.0 [211.2-321.3]. Highest rates were generally found in outer suburban areas. Areas of highest progressive increase in incidence were identified mostly in the Outer West of Sydney with 3-4 fold change over the time period in contrast to the national 35% increase. These areas were broadly associated with higher relative socioeconomic disadvantage.
Conclusions: Spatial and spatio-temporal analyses provide useful techniques to identify emerging hotspots of KRT incidence and could reasonably be employed to inform the distribution and capacity of service delivery in metropolitan areas. Social determinants were highlighted as key drivers of KRT incidence.

Dr Dominic Keuskamp is a Postdoctoral Research Fellow with the Australia & New Zealand Dialysis & Transplant Registry (ANZDATA). He works across a number of data linkage projects investigating population-level predictors and outcomes of kidney replacement therapy (KRT). His research also includes applications of spatial analysis to investigations of KRT.

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