Albuminuria among Alaska Natives – Findings from the Genetics of Coronary Artery Disease in Alaska Natives (GOCADAN) Study

Abstract

Background: The prevalence and associated risk factors for albuminuria and low-grade albuminuria in Alaska Natives is not known. Methods: Cross-sectional analysis of the Genetics of Coronary Artery Disease in Alaska Natives Study. We included 1,026 individuals, who represent 85% of the study participants for whom complete data were available. Risk factors examined were age, sex, education, diabetes, hypertension, obesity, lipids, C-reactive protein, angiotensin-converting enzyme inhibitor use, and smoking status. Urine albumin excretion was estimated by the albumin/creatinine ratio measured from a single random morning urine sample. Albuminuria was defined as an albumin/creatinine ratio of ≧30 mg/g. Low-grade albuminuria was defined as an albumin/creatinine ratio of 10 to <30 mg/g. Results: The mean age was 42 years and over half were female. Diabetes prevalence was low at 3% and the prevalence of hypertension was 20%. The prevalence of albuminuria was 6%; the prevalence of low-grade albuminuria was 12%. Individuals with diabetes or hypertension were 3 times more likely to have albuminuria than those without these conditions [odd ratios: diabetes 3.0 (1.2–7.9) and hypertension 3.0 (1.2–7.3)]. Conclusions: The burden of albuminuria is low. Comprehensive programs and policies are important given the rise in diabetes and hypertension among Alaska Natives.

Uric Acid, Hypertension, and Chronic Kidney Disease Among Alaska Eskimos: The Genetics of Coronary Artery Disease in Alaska Natives (GOCADAN) Study

“…We have previously shown that prevalence of CKD stages 1 and 2, as defined by albuminuria, is lower in Alaska Eskimos 24 than reported for the US general population. 31 In this study we also found that fewer than 10% of GOCADAN participants had prevalent CKD stages 3 through 5, as defined by reduced eGFR, again lower than in the US general population.…”

Racial and Ethnic Differences in Mortality among Individuals with Chronic Kidney Disease

“…One possibility is an increased burden of a multitude of chronic diseases, such as obesity, diabetes, cardiovascular disease, and liver disease (29,30). Importantly, the American Indian/Alaska Native population is made up of over 500 federally recognized tribes, and there are substantial regional differences in the prevalence of diseases (19,(31)(32)(33)(34). We attempted to account for obesity, diabetes, and hypertension in our adjustments; however, we cannot account for severity of disease, all comorbidities, or all regional differences.…”

Cardiovascular Disease Among Alaska Native Peoples

“…40 Similar to the gender differences found in the ASP, 37% (n=602) of the women in the GOCADAN study were obese, compared with 20% (n=456) of the men. 37 Likewise, in CANHR, nearly a third or 32% of the 753 participants were obese and another 33% were overweight.…”

“…62, 63 Albuminuria (urine albumin to creatinine ratio ≥ 30 mg/g), was less prevalent among GOCADAN participants compared with the general U.S. population (6% vs 10%). 40 The prevalence of CKD (estimated glomerular filtration rate <60 mL min 1.73 m 2 ), was likewise low (7%), perhaps because of the lower burden of diabetes thus far. 64 Consistent with the GOCADAN data, the Alaska Native Diabetes Registry reports low rates of end-stage renal disease, again, differing from observations in several American Indian populations.…”

“…9 Of 1026 participants, 48% had high total cholesterol (≥ 200 mg/dL), 32% had high LDL-C (≥ 130 mg/dL), 26% had high triglycerides (≥ 150 mg/dL), and 11% had low HDL-C (≤ 40 mg/dL). 40 Among GOCADAN participants ≥ ages 45 years (n=499), 34% (n=71) of men and 40% (n=115) of women had hyperlipidemia, defined as LDL-C > 160 mg/dL, non-HDL-C >190 mg/dL, Apo-B>120 mg/dL, or taking lipid lowering medications. 14 …”