Warning: this article may contain images of Indigenous people who are now deceased.

Kidney disease is on the rise in Australia, with Kidney Health Australia reporting that two million people have kidney disease and 1.8 million are unaware they have the disease.

Referred to as the silent killer because an individual can lose up to 90 per cent of kidney function before symptoms are apparent, preventative health measures and early detection are vital in tackling kidney disease.

The number of people who reach kidney failure and need dialysis or a transplant over the past two decades, hsa more than doubled from 11,700 people to more than 28,000.

Deloitte recently estimated that Chronic Kidney Disease is currently costing the Australian economy $9.9 billion per year.

Kidney Health Australia Clinical Director Karen Dwyer told National Indigenous Times: "If we look at Australia as a whole, the prevalence is one in ten, but if we look at Indigenous people, it's one in five."

"Underneath that is a huge wave of people with less advanced kidney disease, who if left untreated may reach kidney failure. The numbers are huge and they're getting bigger," she said.

"Across Australia, there's geographical variation in the prevalence of kidney disease. As you move out of major metropolitan cities into more regional, rural and remote, the risk of kidney disease, particularly amongst Indigenous peoples is much greater.

"There are some remote communities where you could say that kidney disease is endemic."

Dr Dwyer said "an interplay of complex factors" are involved in driving the illness.

"We know that people in rural regions have a higher prevalence of some of the factors that increase the risk for or kidney disease such as diabetes, heart disease, smoking" she said.

"The tyranny of distance is a very real issue with access to care reducing as you move further away from major cities."

One Indigenous Elder told National Indigenous Times that adding to the emotional toll of dealing with kidney disease, requiring dialysis and logistics of travel, mob up north have the added burden of frequently being pulled over by police for alcohol inspections, which is demoralising.

Ronald Morgan said receiving the diagnosis "was very disheartening to have that put on you, especially when you're in the middle of all these good stuff, you got planned for your life, you know with kids and your wife, stuff like that".

Please note: this video from Kidney Health Australia was created in 2015, however it provides an accurate presentation of the devastating impact this can have on First Nations Families. The figures quoted in this video have changed but sadly haven't improved.

Dr Dwyer said the high prevalence of kidney disease amongst Indigenous Australians can be attributed to the impact of "the social determinants of health, such as access to health care, fresh healthy foods and education." "Lower birth weights and recurrent childhood infections play into a lot of long term conditions," she said.

"The excess burden of kidney disease reflects the ongoing impacts of colonisation and disadvantage faced by Aboriginal and Torres Strait Islander Peoples."

On the issue of COVID19 infection potentially increasing the chance of developing kidney disease, Dr Dwyer said it is an area "we're still learning about because of the recency of COVID".

"During the first wave of COVID, we saw that people with kidney disease were vulnerable to severe disease. We also saw that people that developed severe COVID infections, subsequently developed kidney disease," she said.

"We know that if you have severe infection, you can get what we call an acute kidney injury. That's where you are really really sick and the kidney goes into "shock". The kidney tends to recover but with every recovery, there is some scarring. I liken it to when you are a kid and you fall over and scrape your knee, your knee heals, but you heal with a scar.

"As for long COVID – this is an emerging area as we continue to learn and understand the mechanisms at play. There may well be an impact on kidney disease, but we're not 100 per cent sure yet.

"I think what's really driving the increased burden of kidney disease over the last twenty years, relates to the prevalence of diabetes, excess weight, particularly around the middle and high blood pressure. These conditions are very closely connected. Diabetes is the biggest driver of kidney disease across Australia, particularly within Indigenous communities where it accounts for about three quarters of all cases of kidney failure."

On prevention, Dr Dwyer referred to Kidney Health Australia's new guidelines for Culturally Safe and Clinical Kidney Care for First Nations Australians published in November last year, based on extensive Indigenous community consultations and which delivered seven main recommendations: Addressing institutional racism and cultural safety; Ensuring community and family involvement; Improving access to transportation and accommodation; Supporting and developing an Indigenous health workforce; Screening for kidney disease and referring early for specialist treatment; Promoting self management of kidney disease through education and public awareness; Exploring alternative models of care that meets the needs of First Nations Australians.

Dr Dwyer said Kidney Health Australia are now at the point of implementation of these guidelines.

"That becomes part of our educational piece and we're making sure that all healthcare professionals are aware of the new recommendations for screening Indigenous people for kidney disease," she said.

"Some of the bigger recommendations really need substantial financial support from government and a coordinated approach from all stakeholders, and led by community."

Minister for Health and Aged Care Mark Butler said on Wednesday that an Indigenous Voice would help the fight against endemic disease.

"As Health Minister, I can't think of an area of policy where that voice will be more important and more valuable than in health," he said.

There are numerous organisations like Kidney Health Australia that have been on the ground undertaking extensive consultation and engagement with First Nations communities for a number of years, who are in desperate need funding.

Deloitte reported that investment in early detection could identify an additional 400,000 cases of chronic kidney disease in its earlier stages and that the provision of best practice treatment to these individuals would drastically improve the disease trajectory of many of these individuals translating to total saving of $10.2 billion over the next 20 years ($509 million annually) across the health system.

Dr Dwyer said regarding early detection of kidney disease, it presents an opportunity to slow the rate of progression and preserve kidney health.

"There's lots that can be done to slow progression and preserve kidney health. Attention to lifestyle factors along with new medications have changed how kidney disease is viewed: from kidney progression to kidney preservation."

This October Kidney Health Australia are running 'Red Socks Run for Kidneys', a fundraiser for the cause.

"People that have dialysis generally have three treatments per week for four to five hours, so it's about sixty hours of dialysis per month," Dr Dwyer said.

"The challenge is for people to do 60 kilometres of activity and raise much needed funds for Kidney Health Australia, which then goes back to communities to support those living with kidney disease and their carers and families."

"A lot of people have to dislocate from community and from their home to receive dialysis. For many in remote Northern Territory, it may require relocating to Darwin which is a huge personal and financial cost for people. Similarly in other areas across Australia, people often need to bypass their nearest town because the dialysis centre is full. But obviously there's a disproportionate effect on Indigenous peoples particularly when living in more remote areas."