The piss test, missed diagnoses and the dialysis crunch: Kidney Action Week

Kidney Health Australia is taking an unconventional approach to a serious health issue, launching a national media campaign during Kidney Action Week that uses toilet humour to encourage Australians to get tested for chronic kidney disease (CKD).

Dubbed Taking The Piss, the campaign is urging Australians to ask their GP for a urine test as part of a broader Kidney Health Check.

“We needed something loud enough to cut through, because the message is not getting across, so we’re using humour to cut through the stigma, and get people finally talking about kidney disease,” said Kidney Health Australia CEO, Chris Forbes.

An estimated 2.5 million Australians are currently unaware they are living with CKD, leaving them at increased risk of heart attack and stroke and potentially depriving them of access to life-saving treatment. The burden on the health system is also escalating. The number of Australians requiring treatment for kidney failure has doubled over the past two decades and is projected to increase by a further 42% by 2030.

“A staggering 77% of people at risk of kidney disease have not had a kidney piss test in the last 24 months. We need Australians at risk to literally take the piss, so we developed a campaign to get the message across,” added Forbes.

For Carla McNaughton, a diagnosis of CKD came incidentally but the disease should have been identified years earlier. At 30, McNaughton was unexpectedly diagnosed with IgA nephropathy, an autoimmune kidney disease. Despite treatment, her kidney function deteriorated and, six years later, she required dialysis.

“After 14 exhausting months managing full-time work and dialysis three nights a week, I received a kidney transplant and am now doing well,” she said. “However, looking back at results from earlier (unrelated) blood tests taken during my mid-twenties, I discovered that signs of early CKD had already been present, but not flagged. I had missed out on the chance of early treatment. My experience highlights how better awareness of CKD could ensure early detection and give people the chance of effective early treatment.”

Treatment options have also expanded in recent years. SGLT2 inhibitors were PBS-listed in 2022, marking the first new treatment for CKD in more than 20 years. Research indicates the medicines can delay CKD progression by 15 years or more. Treatments in this class include AstraZeneca’s Farxiga (dapagliflozin) and Boehringer Ingelheim’s Jardiance (empagliflozin).

Lesley’s experience similarly highlights the consequences of delayed testing. For three years, her body had been signalling that something was wrong. Despite consultations with five different GPs, however, kidney function tests, including a creatinine blood test or urinalysis, were not ordered.

She was ultimately diagnosed with end-stage renal failure at just 29.

“I was considered ‘too young,’ with no family history of kidney disease, no diabetes, and no obvious risk factors – assumptions that ultimately delayed my diagnosis until my kidneys had almost completely failed,” said Lesley.

Her kidney disease followed an even more complex path. In 2009, she was diagnosed with a rare and aggressive autoimmune disease and underwent a year of intensive chemotherapy to achieve remission. The treatment left her with just 20% kidney function. Then, against all odds, she discovered she was pregnant.

“My baby survived but the pregnancy cost me the remainder of my kidney function,” Lesley reflected. “When my baby was only 3 months old, I began peritoneal dialysis, navigating new motherhood alongside life-sustaining treatment. I have now been on dialysis for approximately 15 years. My journey highlights not only the unpredictable nature of kidney disease, but also the critical importance of early detection and testing – regardless of age or perceived risk.”

Beyond earlier diagnosis, the growing burden of kidney failure is placing pressure on Australia’s capacity to provide dialysis.

The scale of the capacity challenge is reflected in a joint report from the Australian and New Zealand Society of Nephrology (ANZSN), the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry and the New Zealand National Clinical Renal Network. The report found that more than 80% of renal units had dialysis waiting lists, while 24% reported having dialysis machines out of service.

Evidence suggests several key barriers to patients commencing home dialysis, with awareness of home-based therapy as an option and comorbidities that can prevent patients from managing treatment independently among the most significant.

“In Australia, much of the cost of dialysis therapy is borne by public hospitals, which face growing pressure to expand dialysis infrastructure and workforce capacity as demand increases,” Matthew Bain, General Manager of Vantive Australia & New Zealand, told Health Industry Hub. “Currently, there are options for patients with private insurance to have nursing assistance for home-based haemodialysis funded by their provider. We see an opportunity for private insurers to expand that assistance to also cover nursing assistance for peritoneal dialysis and create more pathways to home dialysis. Assisted home dialysis is something we are actively working to build support for among providers and payers.”

There is also an economic argument for increasing the use of home-based peritoneal dialysis (PD).

Recent economic analysis commissioned by Vantive found that increasing uptake of home-based PD could improve patient outcomes while generating health system savings compared with in-centre haemodialysis.

The analysis examined current practice in the UK, where approximately 12% of patients receive therapy through PD, against scenarios involving increased PD initiation. Under one scenario, increasing PD uptake to 15.5%, while taking into account the broader ambition of NHS England’s recommendation that 20% of therapy be home-based, including home haemodialysis, could generate nearly £200 million in NHS savings over five years. The findings were presented at the European Renal Association (ERA) Congress in June in Glasgow, Scotland.

Technology is also expanding the possibilities for home-based care. Remote patient monitoring (RPM) platforms such as Sharesource allow clinicians to remotely review treatment data, identify potential problems earlier and make timely adjustments to therapy. For patients receiving PD at home, the technology can also provide reassurance that their care team remains connected to their treatment.

Newly published real-world evidence with a two-year follow-up found that RPM-enabled PD was “associated with improved patient survival, reduced haemodialysis transfer, and fewer annual hospitalisations” compared with conventional PD.

The combination of earlier detection, novel medicines and greater access to home-based care is increasingly important as Australia confronts the projected rise in kidney failure.

“Kidney Action Week is an opportunity to raise awareness of chronic kidney disease, encourage earlier conversations about kidney health and ensure people understand the treatment options available if kidney failure occurs,” said Bains. “It also highlights the importance of empowering patients and care teams with information and support to make the personal decision to start dialysis in a hospital clinic or at home.”

In reimagining healthcare across the entire patient journey, Health Industry Hub^TM is the only one-stop-hub uniting the diversity of the Pharma, MedTech, Diagnostics & Biotech sectors to inspire meaningful change.

The Health Industry Hub^TM content is copyright protected. Access is available under individual user licenses. Please click here to subscribe and visit T&Cs here.