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Clinical outcomes associated with albuminuria in central Australia: a cohort study

Rebecca Ritte1, Joanne Luke2, Craig Nelson3,4

  • 1Onemda Group, Indigenous Health Equity Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Melbourne, 3010, Australia. rebecca.ritte@unimelb.edu.au.

BMC Nephrology
|August 7, 2016
PubMed

Insights

Elevated albumin-to-creatinine ratio (ACR) significantly increases the risk of end-stage kidney disease (ESKD) and dialysis in Aboriginal Australians. Early screening with ACR and the KHA Risk Matrix can identify high-risk individuals in remote communities.

Area of Science:

  • Nephrology
  • Public Health
  • Epidemiology

Background:

  • Chronic kidney disease (CKD) and end-stage kidney disease (ESKD) disproportionately affect Aboriginal communities in central Australia.
  • Under-diagnosis of CKD and ESKD poses a significant health burden in these populations.

Purpose of the Study:

  • To investigate the association between elevated albumin-to-creatinine ratio (ACR) and adverse clinical outcomes in Aboriginal people in central Australia.
  • To identify predictors of CKD progression within this demographic.

Main Methods:

  • A 10-year cohort study analyzed data from 623 Aboriginal individuals across three central Australian communities.
  • Cox proportional hazards models assessed risks of ESKD, dialysis, cardiovascular disease (CVD), and mortality.
  • The Kidney Health Australia (KHA) Risk Matrix was used to examine predictors of albuminuria progression.

Main Results:

  • A baseline ACR level of ≥3.5 mg/mmol was linked to a nearly 10-fold increased risk of ESKD and a 15-fold increased risk of requiring dialysis.
  • Albuminuria ≥3.5 mg/mmol showed a borderline association with a 63% increased risk of CVD.
  • Diabetes and a waist-to-hip ratio ≥0.90 independently predicted a two-fold higher risk of progressing to higher ACR levels.

Conclusions:

  • A single measurement of moderately increased albuminuria strongly predicts renal failure in Aboriginal Australians.
  • Spot urine ACR testing combined with the KHA Risk Matrix offers an efficient screening strategy for CKD and dialysis risk in remote settings.
  • Targeting individuals with diabetes and central obesity for interventions may prevent CKD and CVD complications.
Abstract

Keywords:
Aboriginal peopleAlbumin creatinine ratioAlbuminuriaCohort studyEnd stage renal diseaseRiskRural and remote health

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