Clinical outcomes associated with albuminuria in central Australia: A cohort study

Rebecca Ritte, Joanne Luke, Craig Nelson, Alex Brown, Kerin O'Dea, Alicia Jenkins, James D. Best, Robyn McDermott, Mark Daniel, Kevin Rowley

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish
Article number113
JournalBMC Nephrology
Issue number1
Publication statusPublished or Issued - 5 Aug 2016


  • Aboriginal people
  • Albumin creatinine ratio
  • Albuminuria
  • Cohort study
  • End stage renal disease
  • Risk
  • Rural and remote health

ASJC Scopus subject areas

  • Nephrology

Cite this