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- Title
Clinical outcomes associated with albuminuria in central Australia: a cohort study.
- Authors
Ritte, Rebecca; Luke, Joanne; Nelson, Craig; Brown, Alex; O'Dea, Kerin; Jenkins, Alicia; Best, James D.; McDermott, Robyn; Daniel, Mark; Rowley, Kevin
- Abstract
<bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
AUSTRALIA; ALBUMINURIA; KIDNEY disease diagnosis; DIABETES risk factors; TREATMENT of diabetes; PUBLIC health; DIAGNOSIS; TREATMENT of chronic kidney failure; CARDIOVASCULAR diseases; CHRONIC kidney failure; CREATININE; DIABETES; HEMODIALYSIS; LONGITUDINAL method; OBESITY; URINALYSIS; PREDICTIVE tests; PROPORTIONAL hazards models; RETROSPECTIVE studies; WAIST-hip ratio; DISEASE progression
- Publication
BMC Nephrology, 2016, Vol 17, p1
- ISSN
1471-2369
- Publication type
journal article
- DOI
10.1186/s12882-016-0328-1