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- Title
The multidimensional nature of renal disease: Rates and associations of albuminuria in an Australian Aboriginal community.
- Authors
Hoy, Wendy E; Mathews, John D; McCredie, David A; Pugsley, David J; Hayhurst, Beverly G; Rees, Megan; Kile, Emma; Walker, Kate A; Wang, Zhiqiang
- Abstract
The multidimensional nature of renal disease: Rates and associations of albuminuria in an Australian Aboriginal community. Background. An epidemic of end-stage renal disease (ESRD) is accompanying the rising rates of hypertension, type 2 diabetes and cardiovascular disease among Aborigines in the Northern Territory of Australia. Incidence rates are now 21 times those of nonAboriginal Australians and are doubling every four years. We describe the rates and associations of renal disease in one remote community, which has a current ESRD incidence of 2700 per million, and cardiovascular mortality among the highest in Australia. Methods. Between 1992 and 1995 a community-wide screening program was conducted, in which the urinary albumin/creatinine ratio (ACR) was used as the chief renal disease marker. More than 90% of the population ages five and older participated. Results. Albuminuria was evident in early childhood and increased dramatically with age; 26% of adults had microalbuminuria and 24% had overt albuminuria. All renal failure developed out of a background of overt albuminuria. ACR was significantly correlated with the presence of scabies at screening, with a history of poststreptococcal glomerulonephritis, which is epidemic and endemic in the community, with increasing body wt, blood pressure, glucose, insulin and lipid levels, and with evidence of heavy drinking. ACR was also significantly and inversely correlated with birth weight. As a result of its association with deteriorating hemodynamic and metabolic profiles, increasing ACR was also correlated with increasing cardiovascular risk score. Direct observations showed, and multivariate models predicted, progressive amplification of ACR when multiple risk factors were present simultaneously. Albuminuria also clustered in families. Conclusion. Renal disease in this population is multifactorial, with risk factors related to whole-of-life nutrition, metabolic and hemodynamic profiles, infections, health...
- Subjects
AUSTRALIA; ALBUMINURIA; INDIGENOUS peoples; DISEASES
- Publication
Kidney International, 1998, Vol 54, Issue 4, p1296
- ISSN
0085-2538
- Publication type
Article
- DOI
10.1046/j.1523-1755.1998.00099.x