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High rates of albuminuria but not of low eGFR in Urban Indigenous Australians: the DRUID Study

Maple-Brown, Louise J., Cunningham, Joan, Hodge, Allison M., Weeramanthri, Tarun S., Dunbar, Terry E., Lawton, Paul D., Zimmet, Paul Z., Chadban, Steve J., Polkinghorne, Kevan R., Shaw, Jonathan E. and O'Dea, Kerin (2011). High rates of albuminuria but not of low eGFR in Urban Indigenous Australians: the DRUID Study. BMC Public Health,11(1):346-353.

Document type: Journal Article
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Title High rates of albuminuria but not of low eGFR in Urban Indigenous Australians: the DRUID Study
Author Maple-Brown, Louise J.
Cunningham, Joan
Hodge, Allison M.
Weeramanthri, Tarun S.
Dunbar, Terry E.
Lawton, Paul D.
Zimmet, Paul Z.
Chadban, Steve J.
Polkinghorne, Kevan R.
Shaw, Jonathan E.
O'Dea, Kerin
Journal Name BMC Public Health
Publication Date 2011
Volume Number 11
Issue Number 1
ISSN 1471-2458   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-79956060438
Start Page 346
End Page 353
Total Pages 8
Place of Publication United Kingdom
Publisher BioMed Central Ltd.
Abstract Background: Indigenous Australians have an incidence of end stage kidney disease 8-10 times higher than non-Indigenous Australians. The majority of research studies concerning Indigenous Australians have been performed in rural or remote regions, whilst the majority of Indigenous Australians actually live in urban settings. We studied prevalence and factors associated with markers of kidney disease in an urban Indigenous Australian cohort, and compared results with those for the general Australian population.

Methods: 860 Indigenous adult participants of the Darwin Region Urban Indigenous Diabetes (DRUID) Study were assessed for albuminuria (urine albumin-creatinine ratio≥2.5 mg/mmol males, ≥3.5 mg/mmol females) and low eGFR (estimated glomular filtration rate < 60 mls/min/1.73 m2). Associations between risk factors and kidney disease markers were explored. Comparison was made with the AusDiab cohort (n = 8,936 aged 25-64 years), representative of the general Australian adult population.

Results: A high prevalence of albuminuria (14.8%) was found in DRUID, whilst prevalence of low eGFR was 2.4%. Older age, higher HbA1c, hypertension, higher C-reactive protein and current smoking were independently associated with albuminuria on multiple regression. Low eGFR was independently associated with older age, hypertension, albuminuria and higher triglycerides. Compared to AusDiab participants, DRUID participants had a 3-fold higher adjusted risk of albuminuria but not of low eGFR.

Conclusions: Given the significant excess of ESKD observed in Indigenous versus non-Indigenous Australians, these findings could suggest either: albuminuria may be a better prognostic marker of kidney disease than low eGFR; that eGFR equations may be inaccurate in the Indigenous population; a less marked differential between Indigenous and non-Indigenous Australians for ESKD rates in urban compared to remote regions; or that differences in the pathophysiology of chronic kidney disease exist between Indigenous and non-Indigenous populations.
Keywords albuminuria
low eGFR
Urban Indigenous Australians
end stage kidney disease
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