Progression of kidney disease in indigenous Australians

The eGFR follow-up study

Louise J. Maple-Brown, Jaquelyne T. Hughes, Rebecca Ritte, Federica Barzi, Wendy E. Hoy, Paul D. Lawton, Graham R D Jones, Elizabeth Death, Alison Simmonds, Ashim K. Sinha, Sajiv Cherian, Mark A B Thomas, Robyn McDermott, Alex D.H. Brown, Kerin O’Dea, George Jerums, Alan Cass, Richard J MacIsaac

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background and objectives: Indigenous Australians experience a heavy burden of CKD. To address this burden, the eGFR Follow-Up Study recruited and followed an Indigenous Australian cohort from regions of Australia with the greatest ESRD burden. We sought to better understand factors contributing to the progression of kidney disease. Specific objectives were to assess rates of progression of eGFR in Indigenous Australians with and without CKD and identify factors associated with a decline in eGFR.

Design, setting, participants, & measurements: This observational longitudinal study of Indigenous Australian adults was conducted in >20 sites. The baseline cohort was recruited from community and primary care clinic sites across five strata of health, diabetes status, and kidney function. Participants were then invited to follow up at 2–4 years; if unavailable, vital status, progression to RRT, and serum creatinine were obtained from medical records. Primary outcomes were annual eGFR change and combined renal outcome (first of ≥30% eGFR decline with follow-up eGFR<60 ml/min per 1.73 m2, progression to RRT, or renal death).

Results: Participants (n=550) were followed for a median of 3.0 years. Baseline and follow-up eGFR (geometric mean [95% confidence interval], 83.9 (80.7 to 87.3) and 70.1 (65.9 to 74.5) ml/min per 1.73 m2, respectively. Overall mean annual eGFR change was -3.1 (-3.6 to -2.5) ml/min per 1.73 m2. Stratified by baseline eGFR (≥90, 60–89, <60 ml/min per 1.73 m2), annual eGFR changes were -3.0 (-3.6 to -2.4), -1.9 (-3.3 to -0.5), and -5.0 (-6.5 to -3.6) ml/min per 1.73 m2. Across baseline eGFR categories, annual eGFR decline was greatest among adults with baseline albumin-to-creatinine ratio (ACR) >265 mg/g (30 mg/mmol). Baseline determinants of the combined renal outcome (experienced by 66 participants) were higher urine ACR, diabetes, lower measured GFR, and higher C-reactive protein.

Conclusions: The observed eGFR decline was three times higher than described in nonindigenous populations. ACR was confirmed as a powerful predictor for eGFR decline across diverse geographic regions.

Original languageEnglish
Pages (from-to)993-1004
Number of pages12
JournalClinical Journal of the American Society of Nephrology
Volume11
Issue number6
DOIs
Publication statusPublished - 6 Jun 2016

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Kidney Diseases
Kidney
C-Reactive Protein
Health Status
Chronic Kidney Failure
Medical Records
Observational Studies
Longitudinal Studies
Creatinine
Primary Health Care
Urine
Serum
Population

Cite this

Maple-Brown, Louise J. ; Hughes, Jaquelyne T. ; Ritte, Rebecca ; Barzi, Federica ; Hoy, Wendy E. ; Lawton, Paul D. ; Jones, Graham R D ; Death, Elizabeth ; Simmonds, Alison ; Sinha, Ashim K. ; Cherian, Sajiv ; Thomas, Mark A B ; McDermott, Robyn ; Brown, Alex D.H. ; O’Dea, Kerin ; Jerums, George ; Cass, Alan ; MacIsaac, Richard J. / Progression of kidney disease in indigenous Australians : The eGFR follow-up study. In: Clinical Journal of the American Society of Nephrology. 2016 ; Vol. 11, No. 6. pp. 993-1004.
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abstract = "Background and objectives: Indigenous Australians experience a heavy burden of CKD. To address this burden, the eGFR Follow-Up Study recruited and followed an Indigenous Australian cohort from regions of Australia with the greatest ESRD burden. We sought to better understand factors contributing to the progression of kidney disease. Specific objectives were to assess rates of progression of eGFR in Indigenous Australians with and without CKD and identify factors associated with a decline in eGFR. Design, setting, participants, & measurements: This observational longitudinal study of Indigenous Australian adults was conducted in >20 sites. The baseline cohort was recruited from community and primary care clinic sites across five strata of health, diabetes status, and kidney function. Participants were then invited to follow up at 2–4 years; if unavailable, vital status, progression to RRT, and serum creatinine were obtained from medical records. Primary outcomes were annual eGFR change and combined renal outcome (first of ≥30{\%} eGFR decline with follow-up eGFR<60 ml/min per 1.73 m2, progression to RRT, or renal death). Results: Participants (n=550) were followed for a median of 3.0 years. Baseline and follow-up eGFR (geometric mean [95{\%} confidence interval], 83.9 (80.7 to 87.3) and 70.1 (65.9 to 74.5) ml/min per 1.73 m2, respectively. Overall mean annual eGFR change was -3.1 (-3.6 to -2.5) ml/min per 1.73 m2. Stratified by baseline eGFR (≥90, 60–89, <60 ml/min per 1.73 m2), annual eGFR changes were -3.0 (-3.6 to -2.4), -1.9 (-3.3 to -0.5), and -5.0 (-6.5 to -3.6) ml/min per 1.73 m2. Across baseline eGFR categories, annual eGFR decline was greatest among adults with baseline albumin-to-creatinine ratio (ACR) >265 mg/g (30 mg/mmol). Baseline determinants of the combined renal outcome (experienced by 66 participants) were higher urine ACR, diabetes, lower measured GFR, and higher C-reactive protein. Conclusions: The observed eGFR decline was three times higher than described in nonindigenous populations. ACR was confirmed as a powerful predictor for eGFR decline across diverse geographic regions.",
keywords = "Albuminuria, Australia, Chronic kidney disease, eGFR, End stage kidney disease, Humans, Indigenous Australian, Kidney failure, chronic, Kidney function tests, Longitudinal studies",
author = "Maple-Brown, {Louise J.} and Hughes, {Jaquelyne T.} and Rebecca Ritte and Federica Barzi and Hoy, {Wendy E.} and Lawton, {Paul D.} and Jones, {Graham R D} and Elizabeth Death and Alison Simmonds and Sinha, {Ashim K.} and Sajiv Cherian and Thomas, {Mark A B} and Robyn McDermott and Brown, {Alex D.H.} and Kerin O’Dea and George Jerums and Alan Cass and MacIsaac, {Richard J}",
year = "2016",
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language = "English",
volume = "11",
pages = "993--1004",
journal = "Clinical Journal of the American Society of Nephrology",
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Maple-Brown, LJ, Hughes, JT, Ritte, R, Barzi, F, Hoy, WE, Lawton, PD, Jones, GRD, Death, E, Simmonds, A, Sinha, AK, Cherian, S, Thomas, MAB, McDermott, R, Brown, ADH, O’Dea, K, Jerums, G, Cass, A & MacIsaac, RJ 2016, 'Progression of kidney disease in indigenous Australians: The eGFR follow-up study', Clinical Journal of the American Society of Nephrology, vol. 11, no. 6, pp. 993-1004. https://doi.org/10.2215/CJN.09770915

Progression of kidney disease in indigenous Australians : The eGFR follow-up study. / Maple-Brown, Louise J.; Hughes, Jaquelyne T.; Ritte, Rebecca; Barzi, Federica; Hoy, Wendy E.; Lawton, Paul D.; Jones, Graham R D; Death, Elizabeth; Simmonds, Alison; Sinha, Ashim K.; Cherian, Sajiv; Thomas, Mark A B; McDermott, Robyn; Brown, Alex D.H.; O’Dea, Kerin; Jerums, George; Cass, Alan; MacIsaac, Richard J.

In: Clinical Journal of the American Society of Nephrology, Vol. 11, No. 6, 06.06.2016, p. 993-1004.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Progression of kidney disease in indigenous Australians

T2 - The eGFR follow-up study

AU - Maple-Brown, Louise J.

AU - Hughes, Jaquelyne T.

AU - Ritte, Rebecca

AU - Barzi, Federica

AU - Hoy, Wendy E.

AU - Lawton, Paul D.

AU - Jones, Graham R D

AU - Death, Elizabeth

AU - Simmonds, Alison

AU - Sinha, Ashim K.

AU - Cherian, Sajiv

AU - Thomas, Mark A B

AU - McDermott, Robyn

AU - Brown, Alex D.H.

AU - O’Dea, Kerin

AU - Jerums, George

AU - Cass, Alan

AU - MacIsaac, Richard J

PY - 2016/6/6

Y1 - 2016/6/6

N2 - Background and objectives: Indigenous Australians experience a heavy burden of CKD. To address this burden, the eGFR Follow-Up Study recruited and followed an Indigenous Australian cohort from regions of Australia with the greatest ESRD burden. We sought to better understand factors contributing to the progression of kidney disease. Specific objectives were to assess rates of progression of eGFR in Indigenous Australians with and without CKD and identify factors associated with a decline in eGFR. Design, setting, participants, & measurements: This observational longitudinal study of Indigenous Australian adults was conducted in >20 sites. The baseline cohort was recruited from community and primary care clinic sites across five strata of health, diabetes status, and kidney function. Participants were then invited to follow up at 2–4 years; if unavailable, vital status, progression to RRT, and serum creatinine were obtained from medical records. Primary outcomes were annual eGFR change and combined renal outcome (first of ≥30% eGFR decline with follow-up eGFR<60 ml/min per 1.73 m2, progression to RRT, or renal death). Results: Participants (n=550) were followed for a median of 3.0 years. Baseline and follow-up eGFR (geometric mean [95% confidence interval], 83.9 (80.7 to 87.3) and 70.1 (65.9 to 74.5) ml/min per 1.73 m2, respectively. Overall mean annual eGFR change was -3.1 (-3.6 to -2.5) ml/min per 1.73 m2. Stratified by baseline eGFR (≥90, 60–89, <60 ml/min per 1.73 m2), annual eGFR changes were -3.0 (-3.6 to -2.4), -1.9 (-3.3 to -0.5), and -5.0 (-6.5 to -3.6) ml/min per 1.73 m2. Across baseline eGFR categories, annual eGFR decline was greatest among adults with baseline albumin-to-creatinine ratio (ACR) >265 mg/g (30 mg/mmol). Baseline determinants of the combined renal outcome (experienced by 66 participants) were higher urine ACR, diabetes, lower measured GFR, and higher C-reactive protein. Conclusions: The observed eGFR decline was three times higher than described in nonindigenous populations. ACR was confirmed as a powerful predictor for eGFR decline across diverse geographic regions.

AB - Background and objectives: Indigenous Australians experience a heavy burden of CKD. To address this burden, the eGFR Follow-Up Study recruited and followed an Indigenous Australian cohort from regions of Australia with the greatest ESRD burden. We sought to better understand factors contributing to the progression of kidney disease. Specific objectives were to assess rates of progression of eGFR in Indigenous Australians with and without CKD and identify factors associated with a decline in eGFR. Design, setting, participants, & measurements: This observational longitudinal study of Indigenous Australian adults was conducted in >20 sites. The baseline cohort was recruited from community and primary care clinic sites across five strata of health, diabetes status, and kidney function. Participants were then invited to follow up at 2–4 years; if unavailable, vital status, progression to RRT, and serum creatinine were obtained from medical records. Primary outcomes were annual eGFR change and combined renal outcome (first of ≥30% eGFR decline with follow-up eGFR<60 ml/min per 1.73 m2, progression to RRT, or renal death). Results: Participants (n=550) were followed for a median of 3.0 years. Baseline and follow-up eGFR (geometric mean [95% confidence interval], 83.9 (80.7 to 87.3) and 70.1 (65.9 to 74.5) ml/min per 1.73 m2, respectively. Overall mean annual eGFR change was -3.1 (-3.6 to -2.5) ml/min per 1.73 m2. Stratified by baseline eGFR (≥90, 60–89, <60 ml/min per 1.73 m2), annual eGFR changes were -3.0 (-3.6 to -2.4), -1.9 (-3.3 to -0.5), and -5.0 (-6.5 to -3.6) ml/min per 1.73 m2. Across baseline eGFR categories, annual eGFR decline was greatest among adults with baseline albumin-to-creatinine ratio (ACR) >265 mg/g (30 mg/mmol). Baseline determinants of the combined renal outcome (experienced by 66 participants) were higher urine ACR, diabetes, lower measured GFR, and higher C-reactive protein. Conclusions: The observed eGFR decline was three times higher than described in nonindigenous populations. ACR was confirmed as a powerful predictor for eGFR decline across diverse geographic regions.

KW - Albuminuria

KW - Australia

KW - Chronic kidney disease

KW - eGFR

KW - End stage kidney disease

KW - Humans

KW - Indigenous Australian

KW - Kidney failure, chronic

KW - Kidney function tests

KW - Longitudinal studies

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