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Natural history of chronic kidney disease in Australian Indigenous and non-Indigenous children: a 4-year population-based follow-up study

Leigh Haysom, Rita Williams, Elisabeth M Hodson, Pamela A Lopez-Vargas, Leslie P Roy, David M Lyle and Jonathan C Craig
Med J Aust 2009; 190 (6): 303-306.

Summary

Objective: To describe the natural history and risk of early chronic kidney disease (CKD) in Indigenous Australian populations.

Design, setting and participants: A prospective cohort of 2266 Aboriginal and non-Aboriginal children enrolled from primary schools throughout New South Wales from February 2002 to June 2004 and followed for 4 years.

Main outcome measures: Urinalysis, height, weight, blood pressure, birthweight and sociodemographic status at baseline and 2- and 4-year follow-up; CKD risk factors: haematuria, albuminuria, obesity, and systolic and diastolic hypertension.

Results: 2266 children (55% Aboriginal; 51% male; mean age, 8.9 years [SD, 2.0 years]) were enrolled at baseline. 1432 children (63%) were retested at 2-year follow-up, and 1506 children (67%) at 4-year follow-up. Prevalence of baseline CKD risk factors was frequent (2%–7%), but most abnormalities were transient. Besides persistent obesity (5.0%), persistence of CKD risk factors at final follow-up was low: haematuria (1.9%), albuminuria (2.4%), systolic hypertension (1.5%) and diastolic hypertension (0.2%). There was no difference in prevalence of persistent CKD risk factors between Aboriginal and non-Aboriginal children.

Conclusions: Over 4 years of follow-up, Indigenous Australian children had no increased risk for early evidence of CKD. More than 70% of baseline risk factors were transient, and persistent risk factors were uncommon. Our findings suggest the increased risk for end-stage kidney disease seen in Indigenous adults is not yet manifest in these schoolchildren, and may be potentially preventable.

  • Leigh Haysom1,2
  • Rita Williams1
  • Elisabeth M Hodson1,2
  • Pamela A Lopez-Vargas1
  • Leslie P Roy1,3
  • David M Lyle3
  • Jonathan C Craig1,2

  • 1 Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, NSW.
  • 2 School of Public Health, University of Sydney, Sydney, NSW.
  • 3 University of Sydney, Sydney, NSW.

Correspondence: LeighH@chw.edu.au

Acknowledgements: 

John Knight conceived and drafted the original study design. We thank the Aboriginal communities, Aboriginal medical services, schools, Aboriginal education assistants, Aboriginal area health workers, families, and the Children’s Hospital nursing staff who participated in this study; Bayer for the loan of the Clinitek 50 urinalysis machine; and the Far West Population Health Division and Maari Ma Health Aboriginal Corporation for their assistance in visiting remote communities. We would like to acknowledge the financial support provided by the NHMRC Centre for Clinical Research Excellence in Renal Medicine, the Financial Markets Foundation for Children, and the NHMRC for project grant funding and Leigh Haysom’s Training Scholarship in Indigenous Health Research. Funding bodies had no role in the study design, data collection, analysis or interpretation, or writing of this report.

Competing interests:

None identified.

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