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
UR - http://www.scopus.com/inward/record.url?scp=85017456130&partnerID=8YFLogxK
U2 - 10.2215/CJN.09770915
DO - 10.2215/CJN.09770915
M3 - Article
C2 - 27076636
SN - 1555-9041
VL - 11
SP - 993
EP - 1004
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 6
ER -
