THE MULTIDIMENSIONAL NATURE OF RENAL-DISEASE - RATES AND ASSOCIATIONSOF ALBUMINURIA IN AN AUSTRALIAN ABORIGINAL COMMUNITY

Background. An epidemic of end-stage renal disease (ESRD is accompanyi ng the rising rates of hypertension. type 2 diabetes and cardiovascula r disease among Aborigines in the Northern Territory of Australia. Inc idence rates are now 21 limes those of non Aboriginal Australians and are doubling every four years. We describe the rates and associations of renal disease in one remote community. which has a current ESRD inc idence of 2700 per million, and cardiovascular mortality, among the hi ghest in Australia. Methods. Between 1992 and 1995 a community-wide sc reening program was conducted, in which the urinary albumin/creatinine : ratio, IAC-R) was used as the chief renal disease marker. More than 90% of the population ages five: and older participated. Results. Albu minuria was evident in early childhood and increased dramatically with age:26% of adults had microalbuminuria and 24% had overt albuminuria. All renal failure developed out of a background of overt albuminuria. ACR was significantly correlated with the presence of scabies ai scre ening. with a history; of poststreptococcal glomerulonephritis. which is epidemic and endemic in the community. with increasing body wt, blo od pressure, glucose. insulin and lipid levels. and with evidence of h eavy drinking. ACR wits also significantly and inversely correlated wi th birth weight. ils a result of its association with deteriorating he modynamic and metabolic profiles, increasing ACR was also correlated w ith increasing cardiovascular risk score. Direct observations showed, and multivariate models predicted. progressive amplification of ACR wh en multiple risk factors were present simultaneously. Albuminuria also clustered in families. Conclusion. Renal disease in this population i s multifactorial. with risk factors related to whole-of-life nutrition , metabolic and hemodynamic profiles. infections. health behaviors. an d possibly a family predisposition. Its relationship to low birth weig ht. and it associations with deteriorating metabolic and hemodynamic p rofiles, suggest that renal disease is, in part a component of Syndrom e X which spans the simultaneous increase in metabolic, cardiovascular and renal disease in Aboriginal people. The family clustering might h ave both environmental and genetic causes. and is under further. inves tigation. Must of the identified risk factors arise our of poverty, di sadvantages and accelerated lifestyle change, and the current epidemic can be explained by the confluence of many risk factors in the last f ew decades. The introduction of effective and sustained programs to ad dress social, economic and educational inequities in all Aboriginal co mmunities and of screening and renal- and cardiovascular-protective tr eatment programs for those already afflicted are matters of great urge ncy.