Open Access Research article

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

Louise J Maple-Brown12*, Joan Cunningham1, Allison M Hodge3, Tarun Weeramanthri4, Terry Dunbar5, Paul D Lawton2, Paul Z Zimmet6, Steve J Chadban7, Kevan R Polkinghorne8, Jonathan E Shaw6 and Kerin O'Dea9

Author Affiliations

1 Menzies School of Health Research, Charles Darwin University, Darwin, Australia

2 Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia

3 Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia

4 Department of Health, Government of Western Australia, Perth, Australia

5 Charles Darwin University, Darwin, Australia

6 Baker IDI Heart and Diabetes Institute, Melbourne, Australia

7 Royal Prince Alfred Hospital and University of Sydney, NSW, Australia

8 Department of Nephrology, Monash Medical Centre and Department of Medicine, Monash University, Melbourne, Australia

9 Sansom Institute for Health Research, UniSA, Adelaide, Australia

For all author emails, please log on.

BMC Public Health 2011, 11:346  doi:10.1186/1471-2458-11-346

Published: 19 May 2011

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.