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In Contrast is a new Australian documentary about Aboriginal and Torres Strait Islander people living with chronic kidney disease (CKD), dialysis and the struggle to receive a kidney transplant. Reported by ABC News, the film argues that unequal transplant access is a health-system problem shaped by geography, specialist-service concentration and past donor-assessment practices—not an inevitable outcome for First Nations patients.
Its “silent killer” description refers to CKD’s ability to progress substantially before a person feels unwell. By the time kidney function collapses, treatment may involve regular dialysis or a transplant. The documentary combines patient and clinician accounts with data showing a persistent gap between First Nations people receiving kidney replacement therapy and those living with a functioning transplant.
What is In Contrast about?
In Contrast follows Aboriginal and Torres Strait Islander experiences of CKD, kidney failure, dialysis and transplantation. Peter Crumpton, founder of The Transplant Network, made the documentary after travelling to remote communities and speaking with patients, carers and medical professionals. Screenings have been reported in Sydney and Adelaide, with additional screenings planned.
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Crumpton says his aim is to make the disparity visible and focus attention on practical remedies: “My hope for the documentary is that people realise that this gap exists and that there are solutions to fix it.”
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Whose stories are featured?
Kelli Karrikarringka Owen, a Kaurna, Narungga and Ngarrindjeri woman and Adelaide University public-health researcher, describes spending years on dialysis before receiving a transplant through the national donor program. Her account illustrates both the burden of kidney failure and the difference a successful transplant can make.
Professor Janet Kelly, an Adelaide University nurse researcher, discusses the barriers created when specialist services are concentrated in cities. She also describes changing views about assessing First Nations donors individually rather than relying on assumptions that can exclude suitable donors.
Why is kidney disease called a “silent killer” in this story?
CKD can reduce kidney function for a long time without obvious symptoms. A person may feel relatively well while damage accumulates, so testing is important for people at elevated risk, including those with type 2 diabetes or cardiovascular disease. The phrase does not describe a separate disease; it highlights how easily CKD can remain undetected until kidney failure requires dialysis or transplantation.
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How large is the kidney-health burden for First Nations Australians?
Australian Institute of Health and Welfare (AIHW) figures published in 2026 show the scale of the problem, with each statistic tied to a specific population and year:
| Measure | AIHW figure |
|---|---|
| First Nations adults with biomedical signs of CKD, 2022–24 | 19%, or about 101,500 adults |
| First Nations people receiving kidney replacement therapy, 2024 | About 2,700 people |
| People receiving kidney replacement therapy who had a functioning kidney transplant, 2024 | 18% |
The 2024 kidney-replacement figures should not be merged with the documentary’s separate 2022 comparisons. They describe different years and measures. Together, they show why remaining on dialysis is more common than living with a functioning transplant for many First Nations patients.
Why are transplant outcomes affected by location and the health system?
Patients in rural and remote areas can face long journeys to transplant centres, fewer local specialists and the practical cost of repeated appointments. Dialysis may be available through regional services while transplant assessment, surgery and follow-up are concentrated in major cities. Travel, accommodation, time away from family and work, and continuity of care can all influence whether a person reaches and remains in the transplant pathway.
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How have donor-assessment practices changed?
The documentary discusses historical approaches that treated First Nations donors as a broad risk category. Professor Kelly describes movement toward assessing each potential donor’s health individually. Individual assessment cannot remove every medical risk, but it can reduce blanket exclusions and make decisions more consistent with the person being evaluated.
What does early kidney-function testing involve?
For primary-care clients with type 2 diabetes and/or cardiovascular disease, AIHW reported that 46% of First Nations regular clients aged 18 and over had both an estimated glomerular filtration rate (eGFR) and an albumin-to-creatinine ratio (ACR) recorded within the previous 12 months at June 2025. This is a measure of recorded testing among a defined group of primary-care clients, not a national prevalence rate.
What do eGFR and ACR indicate?
- eGFR estimates how well the kidneys filter blood.
- ACR detects albumin in urine, which can indicate kidney damage.
- Tracking results over time helps clinicians identify decline and adjust care before kidney failure develops.
The documentary is intended to prompt awareness and discussion. Testing decisions and treatment belong with a qualified health professional who knows a person’s medical history.
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Where can people find screening and support?
People concerned about kidney health can start with a general practitioner or Aboriginal Community Controlled Health Service and ask whether kidney-function checks are appropriate. Ask how results will be explained, when they should be repeated and what follow-up is available locally. Those already receiving dialysis or being assessed for transplantation should raise travel, referral and support needs with their renal team.
In Contrast offers a public conversation rather than individual diagnosis or treatment advice. Screening availability and documentary dates vary by location; viewers should confirm details with the screening organiser or their local health service.
What solutions does the documentary put forward?
The film’s central argument is that the gap can be narrowed through earlier detection, reliable follow-up and fair access to transplant assessment. Its themes point to several practical priorities:
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- Increase routine eGFR and ACR testing for people at risk.
- Provide culturally safe care and involve Aboriginal and Torres Strait Islander communities in service design.
- Reduce the distance and cost involved in specialist assessment and post-transplant follow-up.
- Assess potential donors on individual evidence rather than historical group assumptions.
- Improve coordination between primary care, dialysis services and transplant centres.
Frequently Asked Questions
Where is In Contrast screening?
ABC News has reported screenings in Sydney and Adelaide, with more planned. Dates and venues are subject to change, so check announcements from the documentary’s organisers or local screening partners.
Can someone have chronic kidney disease without symptoms?
Yes. Kidney function can decline with few noticeable symptoms, which is why blood and urine tests are used to detect CKD. People with diabetes or cardiovascular disease should ask a clinician whether regular testing is appropriate.
What is the difference between dialysis and a kidney transplant?
Dialysis performs part of the kidneys’ filtering work through a machine or other treatment. A transplant places a donated kidney in the recipient; a functioning transplant can remove the need for ongoing dialysis, although recipients require lifelong medical follow-up.
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No. It refers to First Nations regular primary-care clients aged 18 and over who had type 2 diabetes and/or cardiovascular disease, measured at June 2025. It records whether both eGFR and ACR results were documented in the prior 12 months.
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