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

Ritte, Rebecca, Luke, Joanne, Nelson, Craig, Brown, Alex, O'Dea, Kerin, Jenkins, Alicia, Best, James D., McDermott, Robyn, Daniel, Mark, and Rowley, Kevin (2016) Clinical outcomes associated with albuminuria in central Australia: a cohort study. BMC Nephrology, 17 (113). pp. 1-10.

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Abstract

Background: Chronic 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.

Methods: Cox 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.

Results: A 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.

Conclusions: A 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.

Item ID: 45651
Item Type: Article (Research - C1)
ISSN: 1471-2369
Keywords: Aboriginal people, albuminuria, albumin creatinine ratio, risk, cohort study, end stage renal disease, rural and remote health
Additional Information:

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Funders: National Health and Medical Research Council of Australia (NHMRC)
Projects and Grants: NHMRC #631947, NHMRC #508958, NHMRC #299852
Date Deposited: 07 Sep 2016 07:32
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320220 Pathology (excl. oral pathology) @ 33%
32 BIOMEDICAL AND CLINICAL SCIENCES > 3205 Medical biochemistry and metabolomics > 320506 Medical biochemistry - proteins and peptides (incl. medical proteomics) @ 34%
42 HEALTH SCIENCES > 4202 Epidemiology > 420299 Epidemiology not elsewhere classified @ 33%
SEO Codes: 92 HEALTH > 9205 Specific Population Health (excl. Indigenous Health) > 920506 Rural Health @ 100%
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