Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
BMC Public Health. 2011 May 19;11:346. doi: 10.1186/1471-2458-11-346.
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.
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 m(2)). 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.
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.
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.
澳大利亚原住民患终末期肾病的发病率是非原住民的 8-10 倍。大多数关于澳大利亚原住民的研究都是在农村或偏远地区进行的，而大多数澳大利亚原住民实际上居住在城市地区。我们研究了一个城市澳大利亚原住民队列中与肾脏疾病相关的标志物的患病率和相关因素，并将结果与普通澳大利亚人群进行了比较。
对达尔文地区城市澳大利亚原住民糖尿病（DRUID）研究的 860 名成年原住民参与者进行了蛋白尿（尿白蛋白-肌酐比值男性≥2.5mg/mmol，女性≥3.5mg/mmol）和低肾小球滤过率（估计肾小球滤过率<60ml/min/1.73m2）的评估。探讨了危险因素与肾脏疾病标志物之间的关系。并与代表普通澳大利亚成年人群的 AusDiab 队列（n=8936，年龄 25-64 岁）进行了比较。
DRUID 中蛋白尿的患病率很高（14.8%），而低 eGFR 的患病率为 2.4%。多变量回归分析显示，年龄较大、HbA1c 较高、高血压、较高的 C 反应蛋白和当前吸烟与蛋白尿独立相关。低 eGFR 与年龄较大、高血压、蛋白尿和较高的甘油三酯独立相关。与 AusDiab 参与者相比，DRUID 参与者调整后的蛋白尿风险增加了 3 倍，但低 eGFR 风险没有增加。
鉴于在澳大利亚原住民中观察到的终末期肾病明显增加，这些发现可能表明：蛋白尿可能是肾脏疾病的预后标志物优于低 eGFR；在原住民人群中，eGFR 方程可能不准确；在城市地区与偏远地区相比，原住民和非原住民澳大利亚人之间的终末期肾病发病率差异较小；或者在慢性肾脏病的病理生理学方面，原住民和非原住民人群之间存在差异。
