Dr Paul Lawton
Menzies School of Health Research, Darwin.
Dr Paul Lawton is a kidney specialist with over 17 years’ experience working as a clinician across the Northern Territory, including four years as Director of Northern Territory Renal Services.
In his research, he addresses questions about kidney disease care disparities and outcomes among Indigenous Australians, using larger already existing datasets, including some data linkage. How can we do better for disadvantaged populations, and why aren't we?
Dr Lawton also works clinically as a kidney specialist in Darwin, including at Aboriginal Medical Services. His main clinical interests are chronic kidney disease (particularly in Indigenous Australians) and the management of complex conditions in remote and disadvantaged environments.


Title: Chronic Kidney Disease In Indigenous Australians

For over twenty years Indigenous Australians have had a 3-to-5 fold higher incidence of end-stage kidney disease (ESKD) requiring renal replacement therapy (RRT) than non-Indigenous Australians, clustered particularly around central and northern Australia. Why is this so, and what can be done about it?

The incidence of ESKD requiring RRT correlates closely with area-level measures of socioeconomic disadvantage among Indigenous Australians nationally. Cross-sectional community-based studies in the Top End of the Northern Territory have shown that markers of chronic kidney disease (CKD), particularly albuminuria, correlate with low birth weight, a history of skin sores and/or clinical post-infectious glomerulonephritis, adult obesity and diabetes. 

Recent data confirms that the prevalence of markers of CKD is high in middle-aged Indigenous peoples in central and northern Australia. More concerning is the rate of progression of CKD, which recent research has shown is much higher than rates in either national or other comparable high risk populations overseas. Evidence from overseas suggests that a younger age of onset of CKD increases the relative risk of ESKD more than the risk of death, the reverse with older ages of onset among non-Indigenous people.

Individual community- and clinic-level interventions have reduced death, ESKD and progression of CKD. Clinical adherence to locally adapted guidelines in the Northern Territory is high but the widespread attainment of blood pressure and glycaemic control targets remains difficult.

In conclusion, although many of the causes of CKD and drivers of progression in Indigenous Australians lie outside the control of the health system, there are both efficacious treatments and models of care which are highly likely to be cost-effective in this high-risk group. “Scaling up” these interventions across remote central and northern Australia remains a challenge.