The natural history of renal disease in Australian Aborigines. Part 2. Albuminuria predicts natural death and renal failure

Abstract

All renal failure develops out of a background of persistent albuminuria in this population. More important, albuminuria and, inversely, GFR are powerful markers of risk for nonrenal natural death, including, but not restricted to, cardiovascular deaths. Most of the risk for premature death can be assessed by a simple urine test, and interventions that prevent development and progression of albuminuria and loss of GFR should not only prevent renal insufficiency, but powerfully reduce mortality from natural causes as well.

Association between First Nations ethnicity and progression to kidney failure by presence and severity of albuminuria

“…8,9 We sought to measure the presence and severity of albuminuria and estimate the risk of progression to kidney failure for First Nations people compared with non-First Nations people using a community-based cohort.…”

Secondary Prevention of Renal and Cardiovascular Disease

“…Programs introduced in high-risk populations where no prior treatment exists can be expected to have even greater benefit than ours, which was substituted for a previous less systematic treatment approach. The predictive value of albuminuria for renal and nonrenal death (4) anticipates that rates should fall with an intervention that retards albuminuria progression. A fall in cardiovascular deaths is expected in view of the anti-hypertensive and cardiac and vascular-sparing effects of ACEI.…”

“…Only natural deaths were included as relevant terminal endpoints. These were categorized as all-cause natural death (nonrenal and renal deaths), renal deaths (dialysis or death with chronic renal failure), nonrenal deaths, cardiovascular deaths (primary or contributing), and nonrenal, noncardiovascular deaths; these categories are described in more detail elsewhere (4). Unnatural deaths, due to accidents, suicide, homicide, drownings, and crocodile attack, were not included in analyzed endpoints: participants experiencing these endpoints were censored from their cohorts at the time of the event.…”

“…These problems have been especially serious in the Tiwi Islands (population about 1800, 50% age 20ϩ yr), with high rates of premature adult death, and an incidence of treated ESRD reaching 2760 per million in the mid-1990s (2). In the 1990s, 25% of natural deaths in Tiwi adults were renal deaths, and 42% had a primary or underlying cardiovascular cause (4).…”

“…Albuminuria marks all of the future risk for renal deaths, but also strongly predicts nonrenal deaths, both cardiovascular and nonrenal noncardiovascular (4).…”