The natural history of renal disease in Australian Aborigines. Part 2. Albuminuria predicts natural death and renal failure

Wendy E. Hoy, Zhiqiang Wang, Paul VanBuynder, Philip R.A. Baker, Stephen McDonald, John D. Mathews

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80 Citations (Scopus)

Abstract

Background. The purpose of this study was to describe the relationship of albuminuria and glomerular filtration rate (GFR) with natural death and renal failure in an Australian Aboriginal community with high rates of renal disease. Methods. Study subjects were 825 adults (18+ years, mean 33.6 years) or 88% of adults in a remote community who participated in a health screening program offered between 1990 and 1997. The urinary albumin:creatinine ratio (ACR; g/mol) was used as the renal disease marker. Participants were followed for 1.0 to 9.8 years (mean 5.8 years) until renal failure, death, the start of systematic antihypertensive/renal-protective treatment or June 30, 2000. Results. Sixty-five people reached a terminal end point of renal failure or natural death. Sixteen people developed terminal renal failure, all of whom had an ACR of 34+ at baseline exam. There were 49 other natural deaths, which were also strongly correlated with increasing ACR and decreasing GFR over a wide range. This was observed in people without diabetes and in people with normal and elevated blood pressures. It applied to deaths associated with cardiovascular disease and to deaths without an assigned primary or underlying cardiovascular or renal cause. With adjustment for age, the association with death was more robust with ACR than GFR. When compared with people with an ACR <3.4, the hazard ratio (HR; 95% CI) for nonrenal natural death of persons with an ACR 3.4 to 33 was 3.0 (1.1 to 8.4), with an ACR 34 to 99, it was 5.4 (1.8 to 15.9), and with an ACR 100+, it was 6.5 (2.0 to 21). Regression equations predicted that each tenfold increase in the ACR was associated with a 3.7-fold increase in all-cause natural death: a >400-fold increase in renal deaths, a 4-fold increase in cardiovascular deaths, and a 2.2-fold increase in non-renal noncardiovascular deaths. Eighty-four percent of all-cause natural death was associated with pathologic albuminuria. Conclusion. All renal failure develops out of a background of persistent albuminuria in this population. More important, albuminuria and, inversely, GFR are powerful markers of risk.

Original languageEnglish
Pages (from-to)249-256
Number of pages8
JournalKidney International
Volume60
Issue number1
DOIs
Publication statusPublished - 1 Jan 2001
Externally publishedYes

Keywords

  • Blood pressure
  • Chronic renal insufficiency
  • Diabetes
  • Mortality in Aboriginal cohort
  • Progressive renal disease
  • Renal failure
  • Urine test

ASJC Scopus subject areas

  • Nephrology

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