title: Clinical outcomes associated with albuminuria in central Australia: a cohort study.
abstract: Chronic kidney disease (CKD) and end-stage-kidney disease (ESKD) continue to be under-diagnosed and a major burden for Aboriginal communities in central Australia. The aim of this study was to examine the risk of poor clinical outcomes associated with elevated albumin-to-creatinine ratio (ACR) among Aboriginal people in central Australia.
  
  
  
  Cox proportional hazards models were used to estimate the risk of end stage kidney disease (ESKD), dialysis, CVD (cardiovascular disease) and mortality associated with participants' baseline albuminuria reading from a 10-year cohort study of Aboriginal people (n = 623) from three communities in central Australia. Predictors of progression of albuminuria were also examined in the context of the Kidney Health Australia (KHA) Risk Matrix.
  
  
  
  A baseline ACR level of ≥3.5 mg/mmol was associated with an almost 10-fold increased risk of ESKD (95%CI 2.07-43.8) and a 15-fold risk of dialysis (95%CI 1.89-121). Albuminuria ≥3.5 mg/mmol was also associated with a borderline 63 % increased risk of CVD (95%CI 0.98-2.71). No significant association was observed with mortality from all-causes or chronic disease. Diabetes and a waist-to-hip ratio ≥0.90 independently predicted a two-fold increased risk of a progression to higher ACR levels.
  
  
  
  A single measure of moderately increased albuminuria was a strong predictor of renal failure in this population. A single spot urine ACR analysis in conjunction with the KHA Risk Matrix may be a useful and efficient strategy to screen for risk of CKD and progression to dialysis in remote communities. A focus on individuals with diabetes and/or central obesity for strategies to avoid increases in albuminuria may also prevent future CKD and CVD complications.
authors: Onemda Group, Indigenous Health Equity Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Melbourne, 3010, Australia. rebecca.ritte@unimelb.edu.au.
authors: Rebecca
authors: R
authors: Ritte
authors: Onemda Group, Indigenous Health Equity Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Melbourne, 3010, Australia.
authors: Joanne
authors: J
authors: Luke
authors: Western Health, Footscray, VIC, 3011, Australia.|Northwest Academic Centre, The University of Melbourne, Melbourne, VIC, 3010, Australia.
authors: Craig
authors: C
authors: Nelson
authors: South Australian Health and Medical Research Institute, Adelaide, SA, 5000, Australia.
authors: Alex
authors: A
authors: Brown
authors: Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, 3010, Australia.
authors: Kerin
authors: K
authors: O'Dea
authors: NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, 1450, Australia.
authors: Alicia
authors: A
authors: Jenkins
authors: Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia.|Lee Kong Chian School of Medicine, Imperial College London and Nanyang Technological University, Singapore, Singapore.
authors: James D
authors: JD
authors: Best
authors: Centre for Chronic Disease Prevention, James Cook University, Cairns, QLD, 4870, Australia.
authors: Robyn
authors: R
authors: McDermott
authors: School of Population Health, University of South Australia, Adelaide, SA, 5000, Australia.
authors: Mark
authors: M
authors: Daniel
authors: Onemda Group, Indigenous Health Equity Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Melbourne, 3010, Australia.
authors: Kevin
authors: K
authors: Rowley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000208:ethnology* / Q000652:urine; D001315:Australia / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000208:ethnology*; D003404:Creatinine / Q000652:urine; D003920:Diabetes Mellitus / Q000208:ethnology; D018450:Disease Progression; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology* / Q000401:mortality / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000208:ethnology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D016482:Urinalysis; D049629:Waist-Hip Ratio; D055815:Young Adult
chemical_list: D003404:Creatinine
keywords: Aboriginal people; Albumin creatinine ratio; Albuminuria; Cohort study; End stage renal disease; Risk; Rural and remote health