Abstract
BackgroundIndigenous Australians have an incidence of end stage kidney disease 8-10 times higher than non-Indigenous Australians. The majority of research studies concerning Indigenous Australians have been performed in rural or remote regions, whilst the majority of Indigenous Australians actually live in urban settings. We studied prevalence and factors associated with markers of kidney disease in an urban Indigenous Australian cohort, and compared results with those for the general Australian population.Methods860 Indigenous adult participants of the Darwin Region Urban Indigenous Diabetes (DRUID) Study were assessed for albuminuria (urine albumin-creatinine ratio≥2.5 mg/mmol males, ≥3.5 mg/mmol females) and low eGFR (estimated glomular filtration rate < 60 mls/min/1.73 m2). Associations between risk factors and kidney disease markers were explored. Comparison was made with the AusDiab cohort (n = 8,936 aged 25-64 years), representative of the general Australian adult population.ResultsA high prevalence of albuminuria (14.8%) was found in DRUID, whilst prevalence of low eGFR was 2.4%. Older age, higher HbA1c, hypertension, higher C-reactive protein and current smoking were independently associated with albuminuria on multiple regression. Low eGFR was independently associated with older age, hypertension, albuminuria and higher triglycerides. Compared to AusDiab participants, DRUID participants had a 3-fold higher adjusted risk of albuminuria but not of low eGFR.ConclusionsGiven the significant excess of ESKD observed in Indigenous versus non-Indigenous Australians, these findings could suggest either: albuminuria may be a better prognostic marker of kidney disease than low eGFR; that eGFR equations may be inaccurate in the Indigenous population; a less marked differential between Indigenous and non-Indigenous Australians for ESKD rates in urban compared to remote regions; or that differences in the pathophysiology of chronic kidney disease exist between Indigenous and non-Indigenous populations.
Highlights
Indigenous Australians have an incidence of end stage kidney disease 8-10 times higher than nonIndigenous Australians
Cigarette smoking has been associated with chronic kidney disease (CKD) progression in diabetes [12], and smoking rates among Indigenous Australians range from 50-70% [7,9,13]
The relatively low rate of low eGFR is seemingly at odds with the higher rates of incident end stage kidney disease (ESKD) in Indigenous versus non-Indigenous Australians [1,2], but is consistent with previous observations from two remote communities in northern Australia: 53.1% albuminuria and 6.8% renal impairment in one community [10,24], and 44% albuminuria and 12% renal impairment (MDRD < 60 ml/min/ 1.73 m2) in another community [25]. In both Darwin Region Urban Indigenous Diabetes (DRUID) and two remote Indigenous studies, the proportion of participants with albuminuria was several-fold higher than the proportion with low eGFR, whereas the converse was seen in Australian Diabetes Obesity and Lifestyle (AusDiab)
Summary
Indigenous Australians have an incidence of end stage kidney disease 8-10 times higher than nonIndigenous Australians. Indigenous Australians have an incidence of end stage kidney disease (ESKD) 8-10 times higher than non-Indigenous Australians and life expectancy 15-20 years shorter [1,2,3]. Albuminuria rates are very high amongst Indigenous Australians [5,7,8,9] and are associated with components of the metabolic syndrome [7,8], predictive of kidney failure, all-cause mortality [10], and incident coronary heart disease [11]. Cigarette smoking has been associated with CKD progression in diabetes [12], and smoking rates among Indigenous Australians range from 50-70% [7,9,13]
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