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Abstract
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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0328-1) contains supplementary material, which is available to authorized users.
Highlights
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
Recent social history has resulted in chronic kidney disease (CKD) and end-stage-kidney disease (ESKD) among Aboriginal and Torres Strait Islander communities occurring at disproportionately high rates [1, 2] and has been described as an ‘epidemic’ [3]
Risk associated with abnormal baseline albuminuria A total of 623 people were followed for a total of 6009 person-years
Summary
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 single spot urine ACR measurement is included in the Medicare Adult Health Check for Aboriginal and Torres Strait Islander adults [11] and could be a candidate screening tool for assessing future ESKD risk It is a simple and cost effective method accepted among Aboriginal Health Workers and Aboriginal health service users in remote areas [9] and is amenable to point of care testing [16]. Such a screening tool could trigger preventive strategies for CKD progression including use of appropriate pharmacological and non-pharmacological interventions [4, 15] before a clinical diagnosis of CKD
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