Implementing the eGFR Study in a Remote Site: A Case Study

Australian Aboriginal and Torres Strait Islander peoples suffer high rates of obesity, diabetes and other chronic illness, including chronic kidney disease (2008). The most common and most practical measure of renal function in Australia is performed with a venous blood test as part of the electrolyte urea and creatinine (EUC) assessment. Glomerular filtration rate (GFR) is calculated automatically by the pathology provider every time a EUC is requested by a health practitioner (Mathew 2005). The GFR calculation (based on the modification of diet in renal disease (MDRD) formula) was validated amongst Northern Americans with renal disease (Levey, Bosch et al. 1999). The majority of people in that study were Caucasian; African Americans contributed to 10% of the study population. An indirect and practical measure of renal function is clinically important to Australian Aboriginal and Torres Strait Islander people. The "eGFR Study: Accurate assessment of renal function and progression of CKD in Indigenous Australians" is a national study that is currently recruiting participants in order to validate the accuracy of the MDRD-GFR calculation of renal function. Since the MDRD publication, African Americans utilise a varied equation to calculate renal function. This variation is based on an altered body shape, namely larger muscle mass. Skeletal muscle mass is an important source of creatinine. Creatinine is therefore a biomarker of the efficiency of renal excretion (or function). Other biomarkers have been tested however MDRD remains the mainstay of renal function estimation. The eGFR Study seeks to validate the accuracy of the MDRD formula of renal function amongst Aboriginal and Torres Strait Islander people. The heterogeneity of body shapes (and hence muscle mass) within Indigenous Australians and the earlier onset of chronic preventable disease (cardiovascular and diabetes) necessitates the validation of the MDRD formula. One aim of the eGFR Study is to improve the early detection of renal disease, thereby improving opportunities to access care and deliver improvements in the health and well being of Australian communities. The success of the eGFR Study to meet its projected outcomes is dependent on community involvement and support. The eGFR study has utilised Aboriginal and Torres Strait Islander staff members to meet this objective.