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Chronic Kidney Disease: The AusDiab Study 2005
Dr Kevan Polkinghorne, Associate Professor Steven Chadban,
Professor Robert Atkins
1/7 adult Australians have early CKD
AusDiab Survey April 2001• 11,247 adults (>25yrs) chosen by census
district• Australian nation-representative sample
• 16% had evidence of kidney damage
– Proteinuria: 2.4% (300,000 people)
– GFR < 60ml/min/1.7m2 : 11.2% (1.4m people)
– Haematuria: 4 6%Chadban et al, JASN 14:S131, 2003
NSW1,515
QLD1,634
VIC1,434
TAS1,848
SA1,796
WA1,561
NT1,459
TOTAL: 11,247in 2000
6,400 followed upin 2005
Adjusted HR for all-cause mortality according to baseline risk factors
0.5
1
2
3
4
Hyper
tensio
n
Albuminu
riaIm
paire
d GFR
Smoking CVD
KDM
All-
caus
e m
orta
lity
haza
rd ra
tio
Adjusted for age, sex, total cholesterol, taking lipid-lowering medication, triglycerides and WHR
Background
• The number of new cases (incidence) of end-stage kidney disease in Australia is currently 95/million population per annum, with diabetes being the leading cause
• 30% of all new end-stage kidney disease is due to diabetes - compared with 17% in 1994
• The AusDiab study has enabled, for the first time, the opportunity to determine the rate at which new cases of chronic kidney disease emerge among Australian adults who were free from chronic kidney disease at the time of the initial survey
Objectives
• The objectives are:
• (i) to estimate the incidence (% per year) of both chronic kidney disease and early kidney damage, and
• (ii) to present the risk factors associated with these conditions.
Definitions: Impaired glomerular filtration rate
• New (incident) cases of impaired GFR were defined as:– individuals who had a normal eGFR (>60
mL/min/1.73m2) at baseline, but had an eGFR of <60 mL/min/1.73m2 at follow-up.
Definitions: Albuminuria
• New (incident) cases of albuminuria were defined as:– people who had normal albumin levels in
the urine at baseline, but had a spot urine albumin:creatinine ratio (≥2.5 mg/mmol for males and ≥3.5 mg/mmol for females) at follow-up.
Results: Impaired glomerular filtration rate
Incidence of impaired glomerular filtration rate according to sex
0.4
1.3
0.9
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
Male Female Total
Category
Inci
den
ce (
% p
er
year)
Incidence of impaired glomerular filtration rate according to baseline
age
0.0 0.1 0.0 0.2
1.4
3.6
0.2 0.2
1.31.8
2.4
13.1
0.1 0.1
0.71.0
1.9
7.1
0
2
4
6
8
10
12
14
25-34 35-44 45-54 55-64 65-74 >=75
Baseline age (years)
Incid
en
ce
(%
pe
r ye
ar)
Males
Females
All
Incidence of impaired glomerular filtration rate according to baseline
glucose tolerance status
0.20.5
1.10.8
1.0
1.7
2.3
2.9
0.7 0.8
1.8 1.7
0
1
1
2
2
3
3
4
Normal IFG IGT DM
Baseline glucose tolerance status
Incid
en
ce (
% p
er
year)
Males
Females
All
Incidence of impaired glomerular filtration rate according to baseline
hypertension status
0.1
0.90.8
2.8
0.5
1.8
0
2
4
Normal BP Hypertension
Baseline hypertension status
Inci
denc
e (%
per
yea
r)
Males
Females
All
Impaired glomerular filtration rate: Age & sex adjusted risks
Impaired glomerular filtration rate
Univariate Adjusted for Age & Sex
OR 95% C.I. OR 95% C.I.Glucose tolerance status:
IFG vs normal GT 1.16 0.65 – 2.06 1.31 0.71 – 2.42IGT vs normal GT 2.72 1.98 – 3.72** 1.60 1.14 – 2.24*
1.391.73
DM vs normal GT 2.60 1.75 – 3.87** 0.91 – 2.25•Hypertension vsnormal
3.63 2.81 – 4.70** 1.29 – 2.31**
* p<0.05 ** P<0.001
Results: Albuminuria
Incidence of albuminuria according to sex
1.0
0.6
0.8
0.0
0.2
0.4
0.6
0.8
1.0
1.2
Males Females All
Category
Incid
en
ce
(%
pe
r ye
ar)
Males
Females
All
Incidence of albuminuria according to baseline age
0.2 0.30.7
1.0
3.0
5.1
0.30.5
0.3
0.7
1.2
3.5
0.20.4 0.5
0.9
2.0
4.2
0
1
2
3
4
5
6
25-34 35-44 45-54 55-64 65-74 >=75
Age groups at baseline (years)
Incid
en
ce
(%
pe
r ye
ar)
Males
Females
All
Incidence of albuminuria according to baseline glucose tolerance status
0.81.0
1.5
3.6
0.5
2.3
0.7
2.5
0.6
1.3
1.0
3.1
0
1
2
3
4
Normal IFG IGT DM
Baseline glucose tolerance status
Incid
en
ce (
% p
er
year)
Males
Females
All
Incidence of albuminuria according to baseline hypertension status
0.5
2.2
0.4
1.2
0.5
1.7
0
1
2
3
Normal blood pressure Hypertension
Baseline hypertension status
Incid
en
ce
(%
pe
r ye
ar)
Males
Females
All
Albuminuria: Age & sex adjusted risks
Albuminuria Univariate Adjusted for Age & Sex
OR 95% C.I. OR 95% C.I.Glucose tolerance status:
IFG vs normal GT 2.25 1.40 – 3.63** 1.69 1.04 – 2.75*IGT vs normal GT 1.70 1.14 – 2.52* 1.13 0.75 – 1.70
3.181.86
DM vs normal GT 5.49 3.89 – 7.75** 2.22 – 4.56**•Hypertension vsnormal
3.67 2.81 – 4.81** 1.37 – 2.51**
* p<0.05 ** P<0.001
Key findings (1)• Every year, almost 1.0% of adults
developed chronic kidney disease manifested by a reduction in kidney function (impaired glomerular filtration rate). The risks were higher females and in older people.
• Every year almost 1.0% of adults developed evidence of kidney damage as manifested by the leakage of albumin into the urine (albuminuria). The risks were higher in males and in older people.
Key findings (2)
• Having high blood pressure increased the incidence of impaired glomerular filtration rate and albuminuria three-fold.
• Having diabetes increased the incidence of albuminuria five-fold and of developing a reduction in kidney function two-fold.
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