Only 1.6% of all new patients in Australia were aged 60 or older in 1970, and this increased to 36% in 1990, and 57% by 2009. However, the incidence rate of older patients has stabilized since 2005, especially among Māori and Indigenous Australian patients (Fig. 3). Numbers of new patients with multiple comorbidities have increased over time, especially for vascular and DN patients learn more (Fig. 6). By 2009, 42% of all patients, and 70% of DN patients had two or more comorbidities. Numbers

of older comorbid patients are continuing to increase for DN patients, whereas for other kidney diseases there has only been modest, if any, increase in older comorbid patients since 2005. IR of RRT among Australians 60 years or older was highest in years with low per capita death rates14 (correlation coefficients –0.4 for females and –0.8 for males). Overall, 11% of Indigenous Australian patients were biopsied, compared with 16% for other Australians, giving an adjusted RR of 0.66 (CI 0.61–0.70). Indigenous people were also less likely to receive a pre-emptive transplant than were other Australians (Table 1) (RR = 0.04, CI 0.01–0.14), as were Māori (RR = 0.3, CI 0.1–0.5) and Pacific people (RR = 0.2, CI 0.1–0.3) when compared with other NZ residents, after adjustments for sex, year, age, weight and comorbidities. Indigenous patients were more likely to be referred late than were other Australians (RR = 1.5, CI 1.2–1.8),

as were Māori (RR = 1.9, CI 1.2–3.0) and Pacific (RR = 1.8, CI 1.2–2.4) DN when compared Gefitinib with other NZ patients. Racial discrepancies in late referrals are decreasing over time for Indigenous Urease Australians (P = 0.004 for time : race interaction). Over time, patients have been commencing RRT with lower serum creatinine (higher eGFR), i.e. earlier in the progression of kidney disease (Fig. 7). Mean eGFR at commencement of RRT

increased by 0.22 mL/min per 1.73 m2 per year (adjusted) or 0.23 mL/min per 1.73 m2 (unadjusted) per year. DN patients started RRT at higher values of eGFR (P < 0.001), but the difference between DN and other patients is decreasing over time (P < 0.001 for the diabetes :time interaction) (Fig. 7). The number of new RRT patients in Australia and NZ has been increasing since RRT first became available. Much of this increase since 1990 is due to DN. These increases have not been equal among all demographic groups and continue to evolve. Although Indigenous Australians are considerably more at risk of commencing RRT due to DN than are non-indigenous Australians, this relative difference is decreasing over time. Similar trends are seen among Māori and Pacific people in NZ. These changes reflect a number of contributors. For example, changes in DN will be influenced by the prevalence of diabetes, rates of progression to DN among diabetics, changing competing risks of mortality, and the propensity to treat older and comorbid ESKD patients with RRT.