Progression of kidney disease in Indigenous Australians: the eGFR follow-up study

Maple-Brown, Louise J., Hughes, Jaquelyne T., Ritte, Rebecca, Barzi, Federica, Hoy, Wendy E., Lawton, Paul D., Jones, Graham R.D., Death, Elizabeth, Simmonds, Alison, Sinha, Ashim K., Cherian, Sajiv, Thomas, Mark A.B., McDermott, Robyn, Brown, Alex D.H., O'dea, Kerin, Jerums, George, Cass, Alan, and MacIsaac, Richard J. (2016) Progression of kidney disease in Indigenous Australians: the eGFR follow-up study. Clinical Journal of the American Society of Nephrology, 11 (6). pp. 993-1004.

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View at Publisher Website: http://dx.doi.org/10.2215/CJN.09770915
 
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Abstract

Background and objectives: Indigenous Australians experience a heavy burden of CKD. To address this burden, the eGFR Follow-Up Study recruited and followed an Indigenous Australian cohort from regions of Australia with the greatest ESRD burden. We sought to better understand factors contributing to the progression of kidney disease. Specific objectives were to assess rates of progression of eGFR in Indigenous Australians with and without CKD and identify factors associated with a decline in eGFR.

Design, setting, participants, & measurements: This observational longitudinal study of Indigenous Australian adults was conducted in >20 sites. The baseline cohort was recruited from community and primary care clinic sites across five strata of health, diabetes status, and kidney function. Participants were then invited to follow up at 2–4 years; if unavailable, vital status, progression to RRT, and serum creatinine were obtained from medical records. Primary outcomes were annual eGFR change and combined renal outcome (first of ≥30% eGFR decline with follow-up eGFR<60 ml/min per 1.73 m2, progression to RRT, or renal death).

Results: Participants (n=550) were followed for a median of 3.0 years. Baseline and follow-up eGFR (geometric mean [95% confidence interval], 83.9 (80.7 to 87.3) and 70.1 (65.9 to 74.5) ml/min per 1.73 m2, respectively. Overall mean annual eGFR change was −3.1 (−3.6 to −2.5) ml/min per 1.73 m2. Stratified by baseline eGFR (≥90, 60–89, <60 ml/min per 1.73 m2), annual eGFR changes were −3.0 (−3.6 to −2.4), −1.9 (−3.3 to −0.5), and −5.0 (−6.5 to −3.6) ml/min per 1.73 m2. Across baseline eGFR categories, annual eGFR decline was greatest among adults with baseline albumin-to-creatinine ratio (ACR) >265 mg/g (30 mg/mmol). Baseline determinants of the combined renal outcome (experienced by 66 participants) were higher urine ACR, diabetes, lower measured GFR, and higher C-reactive protein.

Conclusions: The observed eGFR decline was three times higher than described in nonindigenous populations. ACR was confirmed as a powerful predictor for eGFR decline across diverse geographic regions.

Item ID: 46136
Item Type: Article (Refereed Research - C1)
Keywords: Australia; albuminuria; chronic kidney disease; eGFR; end stage kidney disease; humans; indigenous Australian; kidney failure, chronic; kidney function tests; longitudinal studies
Additional Information:

Supplementary material attached.

ISSN: 1555-9041
Funders: Australian National Health and Medical Research Council (NHMRC), Kidney Health Australia, Colonial Foundation, Rebecca L. Cooper Foundation, SeaSwift, Charles and Sylvia Viertel (CSV)
Projects and Grants: NHMRC project grant #545202, NHMRC project grant 1021460, NHMRC program grant #631947, NHMRC fellowship #605837, NHMRC practitioner fellowship #1078477, NHMRC scholarship #490348, NHMRC scholarship #1038529, NHMRC principal research fellowship #1027204, NHMRC program grant #631947, NHMRC fellowship #511081, CSV senior medical research fellowship
Date Deposited: 31 Jan 2017 05:29
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111701 Aboriginal and Torres Strait Islander Health @ 34%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111706 Epidemiology @ 33%
11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110312 Nephrology and Urology @ 33%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920119 Urogenital System and Disorders @ 33%
92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920106 Endocrine Organs and Diseases (excl. Diabetes) @ 33%
92 HEALTH > 9203 Indigenous Health > 920302 Aboriginal and Torres Strait Islander Health - Health Status and Outcomes @ 34%
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