Hoy W E, Baker P R, Kelly A M, Wang Z
Menzies School of Health Research, Darwin, NT.
Med J Aust. 2000 May 15;172(10):473-8.
To describe results of a systematic treatment program to modify renal and cardiovascular disease in an Aboriginal community whose rates of renal failure and cardiovascular deaths are among the highest in Australia.
Longitudinal survey of people during treatment, and comparison of rates of natural death and renal failure with those in a historical control group.
Tiwi Islands (population, about 1800), November 1995 to December 1998.
All adults with blood pressure > or = 140/90, with diabetes and urinary albumin/creatinine ratio (ACR) > or = 3.4 g/mol (microalbuminuria threshold), or with progressive overt albuminuria (ACR > or = 34 g/mol) were eligible for treatment. The historical control group comprised 229 people who satisfied these criteria in the pretreatment period 1992-1995.
Perindopril, combined with calcium-channel blockers and diuretics if needed to achieve blood pressure goals; attempts to improve control of blood glucose and lipid levels; health education.
Blood pressure, ACR, serum creatinine level and glomerular filtration rate (GFR) over two years of treatment; rates of renal failure and natural death compared with control group (analysed on intention-to-treat basis).
258 people enrolled in the program, and 118 had complete data for two years of treatment. In these 118, blood pressures fell significantly, while ACR and GFR stabilised. Rates of the combined endpoints of renal failure and natural death per 100 person-years were 2.9 for the treatment group (95% CI, 1.7-4.6) and 4.8 for the control group (95% CI, 3.3-7.0). After adjustment for baseline ACR category, the relative risk of the treatment group versus the control group for these combined endpoints was 0.47 (95% CI, 0.25-0.86; P = 0.013). Treatment benefit was especially marked in people with overt albuminuria or hypertension and in non-diabetic people. The estimates of benefit were supported by a fall in community rates of death and renal failure.
Aboriginal people can participate enthusiastically in chronic disease management, with rapid, dramatic improvement in clinical profiles and mortality. Similar programs should be introduced urgently into other Aboriginal communities nationwide.
描述一项系统性治疗方案的结果，该方案旨在改善澳大利亚肾衰竭和心血管疾病死亡率最高的原住民社区的肾脏和心血管疾病状况。
对治疗期间的人群进行纵向调查，并将自然死亡率和肾衰竭率与历史对照组进行比较。
提维群岛（人口约1800），1995年11月至1998年12月。
所有血压≥140/90、患有糖尿病且尿白蛋白/肌酐比值（ACR）≥3.4 g/mol（微量白蛋白尿阈值）或患有进行性显性白蛋白尿（ACR≥34 g/mol）的成年人有资格接受治疗。历史对照组由1992 - 1995年治疗前期符合这些标准的229人组成。
培哚普利，必要时联合钙通道阻滞剂和利尿剂以实现血压目标；努力改善血糖和血脂水平的控制；健康教育。
治疗两年期间的血压、ACR、血清肌酐水平和肾小球滤过率（GFR）；与对照组相比的肾衰竭率和自然死亡率（基于意向性治疗进行分析）。
258人参加了该项目，118人有完整的两年治疗数据。在这118人中，血压显著下降，而ACR和GFR稳定。治疗组每100人年的肾衰竭和自然死亡联合终点发生率为2.9（95%可信区间，1.7 - 4.6），对照组为4.8（95%可信区间，3.3 - 7.0）。在对基线ACR类别进行调整后，治疗组与对照组相比这些联合终点的相对风险为0.47（95%可信区间，0.25 - 0.86；P = 0.013）。治疗益处在显性白蛋白尿或高血压患者以及非糖尿病患者中尤为明显。社区死亡率和肾衰竭率的下降支持了益处的评估。
原住民能够积极参与慢性病管理，临床状况和死亡率迅速、显著改善。应在全国其他原住民社区紧急推行类似项目。
