The total number of incident RRT patients in Australia and NZ each year increased markedly over time in both countries – from 644 in 1980, to 2904 in 2009. Much of this increase was due to patients diagnosed with DN as the primary cause of ESKD (hereafter ‘DN patients’) high throughput screening (Fig. 1). Numbers of DN patients increased slightly between 1980 and 1990, when they comprised 17% of all patients, and then increased substantially, comprising 35% of new patients in 2009 (Fig. 1). Since 1990, the total number of patients commencing RRT due

to analgesic nephropathy has decreased, cystic diseases have increased slightly and vascular diseases have increased more so (Fig. 1). Based on this result, we examined rates of DN between 1990 and 2009 in more detail, and found that increases in diabetes type 2 compared to type 1 accounted for nearly all the increase in DN

patients. Patients with diabetes type 2 made up 25% of all DN patients in Australia and NZ in 1980, 58% of patients in 1990, and over 90% by 2009. There is no evidence to suggest substantial diagnostic or attribution bias (Fig. 2). Demographic changes8 during this time are relatively minor compared with changes in per capita incidence rates for DN patients, and crude incidence rates show remarkably similar patterns to numbers of patients. The incidence rate of RRT due to DN increased by 7% per year (confidence interval (CI) 0.67–0.76) after adjusting for age, sex and race. Importantly, changes in incidence rates and RR varied considerably between demographic groups; for most groups the age-specific incident rates have stabilized in the past buy PR-171 2–5 years (Fig. 3). Indigenous people made up 16.7% of incident DN patients in Australia, and only 2.5% of the total Australian population in 2009. Although the differences are not as extreme, Māoris and Pacific people in NZ also had a high incidence rate (IR) of incident RRT due to DN

(Fig. 3). Compared with ‘other Australians’, PtdIns(3,4)P2 the RR of commencing RRT due to DN has been decreasing for Indigenous Australians by 2% (95% CI 1% –3%), Pacific people and particularly Māoris (Fig. 4). Males were overall more likely to commence RRT due to DN than were females (Table 1) (RR = 1.6, 95% CI 1.4–1.8). In contrast, among Indigenous Australians, males were less likely to commence RRT than females (RR = 0.4, 95% CI 0.3–0.6) (Fig. 4). There was no consistent difference between sexes for Pacific people in NZ (P = 0.7). The ratio of males to females with DN has been increasing over time in all groups except ‘other NZ’ (Fig. 4). The incidence rate of RRT varied between primary kidney diseases and age, with a marked increase in rates of most diseases among older people, although the incidence rate has stabilized since 2005 for most diseases (Fig. 5). There has been an overall increase in older people commencing RRT with polycystic kidney disease since 1990 (RR per year = 1.03, 95% CI 1.01–1.04).