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The predictive value of albuminuria for renal and nonrenal natural deaths over 14 years follow-up in a remote aboriginal community.

Wang Z, Hoy WE - Clin Kidney J (2012)

Bottom Line: Australian aboriginal people living in remote regions have extraordinary higher rates of mortality compared with other Australian ethnicities.Higher baseline ACR predicted all categories of natural death, with no apparent lower threshold for effect.Albuminuria was still a remarkable predictor for all-cause natural death over an average of 14 years follow-up interval in this aboriginal community.

View Article: PubMed Central - PubMed

Affiliation: Center for Chronic Disease, School of Medicine , The University of Queensland , Australia.

ABSTRACT

Background: Australian aboriginal people living in remote regions have extraordinary higher rates of mortality compared with other Australian ethnicities. Albuminuria marks the underlying renal disease. This study assessed the predictive value of albuminuria for nonrenal and renal deaths in a remote Australian aboriginal community over a follow-up period of >14 years.

Methods: From 1992 to 1997, 85% of community members participated in a health screen, which included measurement of urine albumin/creatinine (ACR) levels. Deaths and dialysis initiations were recorded until 30 November 2010. The rates of natural nonrenal and renal deaths were assessed over a mean of 14 years in the 956 participants aged 18 years and over at baseline, and mortality associated with baseline levels of albuminuria (ACR ≥ 2.7 mg/mmol) was estimated.

Results: There were 203 natural deaths; 70 were renal deaths and 133 were nonrenal deaths, including 60 cardiovascular disease (CVD) deaths. Higher baseline ACR predicted all categories of natural death, with no apparent lower threshold for effect. Baseline ACR ≥ 2.7 mg/mmol predicted a 3.3-fold increase in all natural deaths, a 2-fold increase in nonrenal deaths and a 1.7-fold increase in CVD deaths, after adjustment for other factors. Eighty-nine percent (62 out of 70) of renal deaths occurred in those with ACR ≥ 34 at baseline, with a 24-fold increase in risk. Albuminuria (ACR ≥ 2.7 mg/mmol) contributed to 66% of risk for all natural deaths over the interval.

Conclusions: Albuminuria was still a remarkable predictor for all-cause natural death over an average of 14 years follow-up interval in this aboriginal community.

No MeSH data available.


Related in: MedlinePlus

Predicted renal and nonrenal death rates (100 person-years) by ACR. Note: the two etched lines stand for actual ACR values equal to 3.4 and 34 mg/mmol, respectively.
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SFS125F2: Predicted renal and nonrenal death rates (100 person-years) by ACR. Note: the two etched lines stand for actual ACR values equal to 3.4 and 34 mg/mmol, respectively.

Mentions: Figure 2 shows predicted renal and nonrenal deaths by log-transformed (Base 2) ACR for people aged ≥18 years. The statistical significance between the two curves has been calculated by comparing their relative operating characteristic (ROC) curves. It indicated that the ROC curve for renal death predicted by ACR is significantly greater than for nonrenal death. The rate of increase of predictions of nonrenal death rate speeds up at ACR level <3.4 mg/mmol, while the threshold for renal death was at a higher ACR level (Figure 2). Table 5 shows that those with an ACR ≥ 2.7 mg/mmol (median) are predicted to have a 3.3-fold increased risk of all natural deaths, and 2.2-fold and 1.9-fold increased risk of nonrenal and CVD deaths, respectively, compared with those with an ACR < 2.7 mg/mmol after adjusting for sex and age. As no renal deaths occurred in those with ACR < 2.7 mg/mmol, the HR of ACR ≥ 2.7 versus ACR < 2.7 could not be calculated (Table 5). However, 89% (62 out of 70) of renal deaths occurred in those with ACR ≥ 34 at baseline, with a HR (95% CI) of 23.8 (8.0–71.2) for females and 23.7 (4.1–135.0) for males after adjustment for a number of risk factors. It also shows that the PAF of natural deaths associated with ACR levels at or above the median value of 2.7 mg/mmol was 66% for all natural deaths, 45% for nonrenal deaths and 34% for CVD death (Table 5).Table 5.


The predictive value of albuminuria for renal and nonrenal natural deaths over 14 years follow-up in a remote aboriginal community.

Wang Z, Hoy WE - Clin Kidney J (2012)

Predicted renal and nonrenal death rates (100 person-years) by ACR. Note: the two etched lines stand for actual ACR values equal to 3.4 and 34 mg/mmol, respectively.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400551&req=5

SFS125F2: Predicted renal and nonrenal death rates (100 person-years) by ACR. Note: the two etched lines stand for actual ACR values equal to 3.4 and 34 mg/mmol, respectively.
Mentions: Figure 2 shows predicted renal and nonrenal deaths by log-transformed (Base 2) ACR for people aged ≥18 years. The statistical significance between the two curves has been calculated by comparing their relative operating characteristic (ROC) curves. It indicated that the ROC curve for renal death predicted by ACR is significantly greater than for nonrenal death. The rate of increase of predictions of nonrenal death rate speeds up at ACR level <3.4 mg/mmol, while the threshold for renal death was at a higher ACR level (Figure 2). Table 5 shows that those with an ACR ≥ 2.7 mg/mmol (median) are predicted to have a 3.3-fold increased risk of all natural deaths, and 2.2-fold and 1.9-fold increased risk of nonrenal and CVD deaths, respectively, compared with those with an ACR < 2.7 mg/mmol after adjusting for sex and age. As no renal deaths occurred in those with ACR < 2.7 mg/mmol, the HR of ACR ≥ 2.7 versus ACR < 2.7 could not be calculated (Table 5). However, 89% (62 out of 70) of renal deaths occurred in those with ACR ≥ 34 at baseline, with a HR (95% CI) of 23.8 (8.0–71.2) for females and 23.7 (4.1–135.0) for males after adjustment for a number of risk factors. It also shows that the PAF of natural deaths associated with ACR levels at or above the median value of 2.7 mg/mmol was 66% for all natural deaths, 45% for nonrenal deaths and 34% for CVD death (Table 5).Table 5.

Bottom Line: Australian aboriginal people living in remote regions have extraordinary higher rates of mortality compared with other Australian ethnicities.Higher baseline ACR predicted all categories of natural death, with no apparent lower threshold for effect.Albuminuria was still a remarkable predictor for all-cause natural death over an average of 14 years follow-up interval in this aboriginal community.

View Article: PubMed Central - PubMed

Affiliation: Center for Chronic Disease, School of Medicine , The University of Queensland , Australia.

ABSTRACT

Background: Australian aboriginal people living in remote regions have extraordinary higher rates of mortality compared with other Australian ethnicities. Albuminuria marks the underlying renal disease. This study assessed the predictive value of albuminuria for nonrenal and renal deaths in a remote Australian aboriginal community over a follow-up period of >14 years.

Methods: From 1992 to 1997, 85% of community members participated in a health screen, which included measurement of urine albumin/creatinine (ACR) levels. Deaths and dialysis initiations were recorded until 30 November 2010. The rates of natural nonrenal and renal deaths were assessed over a mean of 14 years in the 956 participants aged 18 years and over at baseline, and mortality associated with baseline levels of albuminuria (ACR ≥ 2.7 mg/mmol) was estimated.

Results: There were 203 natural deaths; 70 were renal deaths and 133 were nonrenal deaths, including 60 cardiovascular disease (CVD) deaths. Higher baseline ACR predicted all categories of natural death, with no apparent lower threshold for effect. Baseline ACR ≥ 2.7 mg/mmol predicted a 3.3-fold increase in all natural deaths, a 2-fold increase in nonrenal deaths and a 1.7-fold increase in CVD deaths, after adjustment for other factors. Eighty-nine percent (62 out of 70) of renal deaths occurred in those with ACR ≥ 34 at baseline, with a 24-fold increase in risk. Albuminuria (ACR ≥ 2.7 mg/mmol) contributed to 66% of risk for all natural deaths over the interval.

Conclusions: Albuminuria was still a remarkable predictor for all-cause natural death over an average of 14 years follow-up interval in this aboriginal community.

No MeSH data available.


Related in: MedlinePlus