Clinical outcomes associated with albuminuria in central Australia: a cohort study

BMC Nephrology

Research Article

Robyn McDermott¹  James D. Best²  Kerin O’Dea³  Alicia Jenkins⁴  Rebecca Ritte⁵  Joanne Luke⁵  Kevin Rowley⁵  Mark Daniel⁶  Alex Brown⁷  Craig Nelson⁸ 

[1] Centre for Chronic Disease Prevention, James Cook University, 4870, Cairns, QLD, Australia;Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, 3010, Melbourne, VIC, Australia;Lee Kong Chian School of Medicine, Imperial College London and Nanyang Technological University, Singapore, Singapore;Melbourne School of Population and Global Health, The University of Melbourne, 3010, Melbourne, VIC, Australia;NHMRC Clinical Trials Centre, University of Sydney, 1450, Camperdown, NSW, Australia;Onemda Group, Indigenous Health Equity Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, 3010, Melbourne, VIC, Australia;School of Population Health, University of South Australia, 5000, Adelaide, SA, Australia;South Australian Health and Medical Research Institute, 5000, Adelaide, SA, Australia;Western Health, 3011, Footscray, VIC, Australia;Northwest Academic Centre, The University of Melbourne, 3010, Melbourne, VIC, Australia;

关键词: Aboriginal people;    Albuminuria;    Albumin creatinine ratio;    Risk;    Cohort study;    End stage renal disease;    Rural and remote health;   

DOI  :  10.1186/s12882-016-0328-1

 received in 2015-02-16, accepted in 2016-08-02,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundChronic kidney disease (CKD) and end-stage-kidney disease (ESKD) continue to be under-diagnosed and a major burden for Aboriginal communities in central Australia. The aim of this study was to examine the risk of poor clinical outcomes associated with elevated albumin-to-creatinine ratio (ACR) among Aboriginal people in central Australia.MethodsCox proportional hazards models were used to estimate the risk of end stage kidney disease (ESKD), dialysis, CVD (cardiovascular disease) and mortality associated with participants’ baseline albuminuria reading from a 10-year cohort study of Aboriginal people (n = 623) from three communities in central Australia. Predictors of progression of albuminuria were also examined in the context of the Kidney Health Australia (KHA) Risk Matrix.ResultsA baseline ACR level of ≥3.5 mg/mmol was associated with an almost 10-fold increased risk of ESKD (95%CI 2.07-43.8) and a 15-fold risk of dialysis (95%CI 1.89-121). Albuminuria ≥3.5 mg/mmol was also associated with a borderline 63 % increased risk of CVD (95%CI 0.98-2.71). No significant association was observed with mortality from all-causes or chronic disease. Diabetes and a waist-to-hip ratio ≥0.90 independently predicted a two-fold increased risk of a progression to higher ACR levels.ConclusionsA single measure of moderately increased albuminuria was a strong predictor of renal failure in this population. A single spot urine ACR analysis in conjunction with the KHA Risk Matrix may be a useful and efficient strategy to screen for risk of CKD and progression to dialysis in remote communities. A focus on individuals with diabetes and/or central obesity for strategies to avoid increases in albuminuria may also prevent future CKD and CVD complications.

【 授权许可】

CC BY   
© The Author(s). 2016