Contribution of cardiometabolic risk factors to estimated glomerular filtration rate decline in Indigenous Australians with and without albuminuria - the eGFR Follow‐up Study

Elizabeth L.M. Barr, Federica Barzi, Jaquelyne T. Hughes, George Jerums, Kerin O'Dea, Alex D.H. Brown, Elif I. Ekinci, Graham R.D. Jones, Paul D. Lawton, Ashim Sinha, Richard J. MacIsaac, Alan Cass, Louise J. Maple-Brown

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    Abstract

    Background: Risk factors for estimated glomerular filtration rate (eGFR) decline beyond albuminuria are not fully understood in Indigenous Australians who have a 6‐fold risk of end‐stage kidney disease. We assessed associations between cardio‐metabolic risk factors and eGFR decline according to baseline albuminuria status to identify potential treatment targets.

    Methods: The eGFR Follow‐up study is a longitudinal cohort of 520 Indigenous Australians. Linear mixed regression was used to estimate associations between baseline cardio‐metabolic risk factors and annual Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPI) eGFR change (ml/min/1.73 m2/year), among those classified with baseline normoalbuminuria (uACR <3 mg/mmol; n = 297), microalbuminuria (uACR 3‐30 mg/mmol; n = 114) and macroalbuminuria (uACR ≥30 mg/mmol; n = 109).

    Results: After a median of 3.0 years of follow‐up, progressive declines of the age‐ and sex‐adjusted mean eGFR was observed across albuminuria categories (‐2.0 [‐2.6 to‐1.4], ‐2.5 [‐3.7 to ‐1.3] and ‐6.3 [‐7.8 to ‐4.9] ml/min/1.72 m2/year). Although a borderline association was observed between greater baseline HbA1c and eGFR decline in those with macroalbuminuria (p = 0.059), relationships were not significant in those with microalbuminuria (p = 0.187) or normoalbuminuria (p = 0.23). Greater baseline blood pressure, C‐reactive protein, waist‐to‐hip ratio and lower HDL cholesterol showed non‐significant trends with greater eGFR decline in the presence of albuminuria.

    Conclusion: This study demonstrated that in a three year period marked eGFR decline was observed with greater baseline albuminuria. Cardio‐metabolic risk factors were not strong predictors for eGFR decline in Indigenous Australians without albuminuria. Longer follow‐up may elucidate the role of these predictors and other mechanisms in CKD progression in this population.
    Original languageEnglish
    Pages (from-to)682-689
    Number of pages26
    JournalNephrology
    Volume23
    Issue number7
    DOIs
    Publication statusPublished - 1 Jul 2018

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