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Aim: To describe adults with (non‐dialysis) chronic kidney disease (CKD) in nine public renal practice sites in the Australian state of Queensland. Methods: 7,060 persons were recruited to a CKD Registry in May 2011 and until start of kidney replacement therapy (KRT), death without KRT or June 2018, for a median period of 3.4 years. Results: The cohort comprised 7,060 persons, 52% males, with a median age of 68 yr; 85% had CKD stages 3A to 5, 45.4% were diabetic, 24.6% had diabetic nephropathy, and 51.7% were obese. Younger persons mostly had glomerulonephritis or genetic renal disease, while older persons mostly had diabetic nephropathy, renovascular disease and multiple diagnoses. Proportions of specific renal diagnoses varied >2‐fold across sites. Over the first year, eGFR fell in 24% but was stable or improved in 76%. Over follow up, 10% started KRT, at a median age of 62 yr, most with CKD stages 4 and 5 at consent, while 18.8% died without KRT, at a median age of 80 yr. Indigenous people were younger at consent and more often had diabetes and diabetic kidney disease and had higher incidence rates of KRT. Conclusion: The spectrum of characteristics in CKD patients in renal practices is much broader than represented by the minority who ultimately start KRT. Variation in CKD by causes, age, site and Indigenous status, the prevalence of obesity, relative stability of kidney function in many persons over the short term, and differences between those who KRT and die without KRT are all important to explore. Summary at a glance: This profile of CKD in public renal practices in Queensland, the first in any Australian state, exposes a much broader spectrum of characteristics than represented by those who ultimately start KRT, major variations in weightings of causes by age group, Indigenous status and practice site, strong links to obesity, and short‐term stability of renal function in many persons, all of which can influence design and evaluation of intervention strategies and inform public health policy. [ABSTRACT FROM AUTHOR]

The article discusses the clinical findings and kidney morphology in chronic kidney disease of unknown cause (CKDu) in India. CKDu is a type of kidney disease that has been increasing worldwide, and it is believed that chronic dehydration from agricultural work in severe heat exposure may be a common risk factor. The study conducted kidney biopsies on 13 CKDu patients in India and found that their kidney biopsy findings were consistent with CKDu cases from other countries, showing focal glomerular collapse, periglomerular fibrosis, and tubulointerstitial scarring. The article also suggests that individuals with fewer nephrons may be more susceptible to CKDu when exposed to chronic dehydration. Additionally, there is a potential association between high temperature, dehydration, and the risk of CKDu across generations. [Extracted from the article]

Background: Progression of kidney disease is a deceptively simple word for a complex bio‐clinical process, evidenced by the number of definitions in the literature. This has led to confusion and differences in interpretation of studies. Methods: We describe different patterns of progression, the performance of different definitions of progression and factors associated with chronic kidney disease (CKD) progression in a public renal service in Australia, in a study of patients enrolled in the CKD.QLD Registry with a minimum of 2 years' follow up. Results: Nine patterns of changing estimated glomerular filtration rate (eGFR) over two consecutive 12‐month periods were identified. Most common was a stable eGFR over 2 years (30%), and the least was a sustainable improvement of eGFR over both periods (2.1%). There was a lack of congruence between the several definitions of progression of CKD evaluated. More people progressed using the definition of decline of eGFR of >5 mL/min/1.73 m2/year (year 1 = 30.2%, year 2 = 20.7%) and the least using development of end‐stage renal disease (year 1 = 5.4%, year 2 = 9.9%). Age (40–59, ≥80 years), degree of proteinuria at baseline (nephrotic range) and CKD aetiology (renal vascular disease, diabetic nephropathy) were significantly associated with eGFR decline over 2 years. Conclusions: This is one of the first demonstrations of the great variations among and within individuals in the progression of CKD over even a period as short as 2 years. Findings suggest considerable potential for renal function recovery and stability while demonstrating the importance of using identical definitions for comparisons across datasets from different sources. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease, Queensland (CKD.QLD) is a multidisciplinary, collaborative research platform for CKD in Queensland. Most public renal services contribute towards the CKD Registry, including Toowoomba Hospital, which is a referral hospital for Darling Downs Health serving a largely regional population in Queensland. We aim to present the profile of the CKD cohort recruited to the CKD.QLD Registry from Toowoomba Hospital, the first comprehensive report on a pre‐dialysis population from regional Australia. Methods: Study subjects were patients in the Darling Downs Health Service who consented to be included in the CKD.QLD registry from June 2011 to December 2016. Those who were on renal replacement therapy (RRT) were excluded. Patients were followed until date of RRT, death, discharge or loss to follow up or a censor date of 30th June 2017. Results: Overall 1051 subjects, representing 13% of all CKD.QLD Registry patients gave consent of whom, 42.7% were ≥70 years of age. The mean age was 63.8 ± 15.1 years (median age 67 years) with male predominance (55.4%). The majority were born in Australia (86.4%). Aboriginal and Torre Strait Islanders (A&TSI) constituted 9.6% of the cohort. The predominant CKD stages were 3b (28.9%) and 4 (27.7%). Hypertension and diabetes were noted in 91% and 44% of subjects, respectively. Diabetic nephropathy was the leading cause of CKD (26.7%) followed by renovascular disease (17.3%) and glomerulonephritis (14.8%). In 12%, the diagnosis was uncertain. Major co‐morbidities included coronary artery disease (24.7%) chronic lung disease (14.8%), cerebrovascular disease (11.6%) and peripheral vascular disease (8.9%). Non‐vascular co‐morbidities included arthritis (24.6%), gout (23.6%) and gastro‐oesophageal reflux disease (19%). The multi‐morbidity profile was differed by gender, diabetic status and age. Over a follow‐up period upto 72 months, 93 (8.8%) started RRT and 175 (16.6%) died. Of those 82% died without RRT and 18% died after RRT. Conclusion: This CKD Registry cohort from regional Queensland consisted mainly of older Caucasians with male predominance. A&TSI patients were overrepresented compared to the overall population. A significant proportion had cardio‐vascular disease and multiple co‐morbidities which differed by gender, diabetic status and age. This report provides valuable data for health services planning and delivery in regional Queensland. SUMMARY AT A GLANCE: This paper reports the profile of patients with chronic kidney disease (CKD) in a regional population of Australia registered in the Queensland CKD registry. The cohort mainly comprises older Caucasian males but with over representation of Australian indigenous people. Not unexpectedly, CKD was associated with significant comorbidities, in particular cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Background Indigenous Australians are significantly burdened by chronic kidney disease (CKD). Elevated levels of C-reactive protein (CRP) have been associated with diabetes and cardiovascular incidence in previous studies. Elevated CRP has been associated with albuminuria and reduced eGFR in cross-sectional studies. This study investigated the long-term predictive association between CRP measured at a baseline exam and the incidence of a CKD-related hospitalization. Methods Health screening examinations were conducted in individuals of a remote indigenous Australian community between 1992 and 1998. The risk of subsequent CKD hospitalisations, documented through Northern Territory hospital records up to 2010, was estimated with Cox proportional hazard models in people aged over 18 years at the baseline screen and who had albumin-creatinine ratios (ACRs) less than 34g/mol. Results 546 participants were eligible for our study. Individuals in the highest CRP tertile at baseline had increased levels of traditional cardiovascular risk factors. They also had almost 4 times the risk of a CKD-related hospitalisation compared with participants in the lowest CRP tertile (HR=3.91, 95%CI 1.01-15.20, P=0.049) after adjustment for potential confounding factors. Participants with CRP concentrations greater than 3mg/L had almost 3 times the risk of CKD hospitalisations than those ≤3mg/L (HR=2.84, 95%CI 1.00-8.00, P=0.049). Furthermore, risk of CKD hospitalisations increased 34% per doubling of baseline CRP (HR=1.34, 95%CI 1.04-1.74, P=0.024). Conclusion In individuals in this remote indigenous community without overt albuminuria at baseline the risk for incident CKD related hospitalisations was predicted by elevated C-reactive protein levels almost a decade earlier. Further research is needed to understand the roles that CRP and systemic inflammation play in CKD risk. [ABSTRACT FROM AUTHOR]

We summarize new knowledge that has accrued in recent years on chronic kidney disease (CKD) in Indigenous Australians. CKD refers to all stages of preterminal kidney disease, including end-stage kidney failure (ESKF), whether or not a person receives renal replacement therapy (RRT). Recently recorded rates of ESKF, RRT, non-dialysis CKD hospitalizations and CKD attributed deaths were, respectively, more than sixfold, eightfold, eightfold and threefold those of non-Indigenous Australians, with age adjustment, although all except the RRT rates are still under-enumerated. However, the nationwide average Indigenous incidence rate of RRT appears to have stabilized. The median age of Indigenous people with ESKF was about 30 years less than for non-Indigenous people, and 84% of them received RTT, while only half of non-Indigenous people with ESKF did so. The first-ever (2012) nationwide health survey data showed elevated levels of CKD markers in Indigenous people at the community level. For all CKD parameters, rates among Indigenous people themselves were strikingly correlated with increasing remoteness of residence and socio-economic disadvantage, and there was a female predominance in remote areas. The burden of renal disease in Australian Indigenous people is seriously understated by Global Burden of Disease Mortality methodology, because it employs underlying cause of death only, and because deaths of people on RRT are frequently attributed to non-renal causes. These data give a much expanded view of CKD in Aboriginal people. Methodologic approaches must be remedied for a full appreciation of the burden, costs and outcomes of the disease, to direct appropriate policy development. [ABSTRACT FROM AUTHOR]

The article discusses a study on the low birthweight in infants that affects adults for chronic disease mortality in the Aboriginal Australians. It associates lower birthweights with higher blood pressures, hyperinsulinaemia and diabetes in young Aboriginals. The study made use of people whose birthweights were recorded and born alive to Aboriginal mothers from a homogenous ethnic group in a coast of the Northern Territory. It concludes that with lower mortalities in infancy and childhood, babies born with lower birthweights can survive to adult life.

Objective: To quantify Indigenous mortality in the Northern Territory by remoteness of residence.Design, Setting and Participants: Australian Bureau of Statistics mortality data were used to compare rates of death from chronic disease in the NT Indigenous population with rates in the general Australian population over the period 1998-2003. Rates were evaluated by categories of remoteness based on the Accessibility/Remoteness Index of Australia: outer regional areas (ORAs), remote areas (RAs) and very remote areas (VRAs).Main Outcome Measures: Mortality from cardiovascular disease, diabetes and renal disease; standardised mortality ratios (SMRs); percentage change in annual death rates; changes in mortality between 1998-2000 and 2001-2003.Results: In 1998-2000, SMRs for all-cause mortality were 285% in ORAs, 875% in RAs and 214% in VRAs. In 2001-2003, corresponding SMRs were 325%, 731% and 208%. For the period 1998-2003, percentage changes in annual all-cause mortality were 4.4% (95% CI, -2.2%, 11.5%) in ORAs, -5.3% (95% CI, -9.6%, -0.8%) in RAs, and 1.1% (95% CI, -7.2%, 11.3%) in VRAs. In 2001-2003, compared with 1998-2000, changes in the number of Indigenous deaths were +35 in ORAs, -37 in RAs and +32 in VRAs. Similar patterns were observed for cardiovascular mortality.Conclusions: Compared with mortality in the general Australian population, Indigenous mortality was up to nine times higher in RAs, three times higher in ORAs and two times higher in VRAs. The fact that rates were lowest in VRAs runs contrary to claims that increasing remoteness is associated with poorer health status. Despite the high death rate in RAs, there was a downward trend in mortality in RAs over the study period. This was partly attributable to a fall in the absolute number of deaths. [ABSTRACT FROM AUTHOR]

Aim: Indigenous Australians have much higher mortality than non-Indigenous Australians. We aimed to quantify the excess of deaths with a renal causal assignment among Indigenous people aged 25 years and over in Queensland, Australia, 1997–2000 and their distribution by remoteness. Methods: Both underlying and associated causes defined by ICD, 10th edition, were examined. Mortality rates were standardized to the concurrent non-Indigenous population. Results: In Indigenous people, standardized mortality ratios with a renal assignment of death by remoteness of residence were 194% (Major City and Inner Regional), 439% (Outer Regional and Remote) and 782% (Very Remote). Of all these deaths with a renal assignment, only 18% had a renal assignment as the underlying cause. Diabetes and cardiovascular disease were frequent concomitant causes in deaths with a renal assignment. Conclusion: The Indigenous population in Queensland has elevated rates of renal deaths compared with the non-Indigenous population. This disparity increases markedly with increasing remoteness of residence. Reliance on underlying causes of death alone greatly underestimates the association of renal disease with deaths in this population. [ABSTRACT FROM AUTHOR]

Changes in glomerular volume ( Vglom) play an important role in the initiation and progression of various glomerulopathies. Estimation of Vglom in the normal kidney provides baseline values for studies of glomerular hypertrophy in disease. The traditional model-based method of Weibel and Gomez is widely applied to estimate Vglom in clinical biopsy specimens. Assumptions of glomerular size distribution and shape required by this method are potential sources of bias that have not been verified. We evaluated the applicability of the glomerular size distribution coefficient in estimating Vglom in human kidneys. Vglom of 720 non-sclerotic glomeruli in histologically normal kidneys of 24 males (20–69 years) was estimated by the unbiased disector/Cavalieri approach. Accurate glomerular diameters were calculated from Cavalieri estimates of Vglom assuming glomerular sphericity. The coefficients of variation (CV) of glomerular diameters were compared with the corresponding values of the size distribution coefficient predicted by the Weibel and Gomez method. Mean (SD) glomerular diameter was 201 (28) mm (range 110–276 mm). The CV of glomerular diameter within each kidney ranged from 4.9 to 14.6%. Corresponding glomerular size distribution coefficients predicted by the formula of Weibel and Gomez ranged from 1.00 to just 1.03. The value of the size distribution coefficient required by the Weibel and Gomez technique when estimating Vglom in normal human kidneys is remarkably constant. This is despite large variations in Vglom. Future studies should examine the extent of bias introduced by the glomerular shape assumptions of this method. [ABSTRACT FROM AUTHOR]

Rates of albuminuria and haematuria are extremely high with haematuria prevalence as high as 30–50% in adults of some Aboriginal groups. Dipstick testing of urine is routinely carried out in Aboriginal communities and as part of school screening programmes. Evaluation of the many affected individuals has traditionally included renal ultrasound examination, which involves considerable expense and logistic problems in remote communities. The present study was conducted to evaluate the usefulness of ultrasound in this setting. A population survey was conducted in a remote community. Urine dipstick analysis and the albumin : creatinine ratio (ACR; g/mol) were measured in 1440 people over 5 years of age (89% of the eligible population), and a detailed renal ultrasound examination was performed in a random subset of 647 people (41.1% of the whole group), 276 aged 5–19 years and 371 over 20 years of age. Urine dipstick proteinuria (>1+) was present in 8.5% (23/271) of those aged 5–19 years and 37.9% (132/348) in those aged over 20 years; pathological albuminuria (ACR > 3.4) was present in 7.6% (21/276) and 54.7% (203/371), respectively, and isolated haematuria was present in 7.7% (21/273) and 11.5% (40/347), respectively. Eight ultrasound abnormalities were found. Ultrasound findings did not change the management of any individual. Renal ultrasound added little to the evaluation of people with asymptomatic proteinuria or haematuria in this setting. In this scenario, ultrasound examination could be reserved for the cases with an unusual presentation where findings are likely to influence the prognosis or treatment, or in preparation for a renal biopsy. [ABSTRACT FROM AUTHOR]

1. Predictors of natural and cardiovascular death were examined in a cohort from a remote Australian Aboriginal community with high mortality rates. The cohort was marked by high prevalences of diabetes (17%), hypertension (19% diastolic blood pressure (BP) > 90 mmHg), obesity (16% body mass index (BMI) > 30), albuminuria (26% albumin/creatinine ratio (ACR) ≥ 34 g/mol) and renal failure (26% calculated glomerular filtration rate < 80 mL/min). 2. Relationships between baseline characteristics and subsequent mortality were examined using multivariate techniques. 3. Albuminuria, diabetes and hypertension (but not smoking dyslipidaemia or obesity) were all markers for increased risk of natural and especially of cardiovascular death. Age- and sex-adjusted relative risk [95% CI] of natural deaths were 4.3 [1.9–9.5] for overt albuminuria (ACR ≥ 34, 3.2 (range 1.6–6.5) for diastolic BP ≥ 100 and 3.7 (range 1.5–8.9) for diabetes. 4. The relative risk associated with albuminuria was independent of diabetes and hypertension. Albuminuria was more common than either diabetes or hypertension and represents a target for intervention to reduce not only progression to renal disease, but also overall mortality. [ABSTRACT FROM AUTHOR]

Evaluates the rates and associations of the renal disease underlying an epidemic of renal failure among Aboriginal people in a remote location in the Northern Territory of Australia. Detection of renal disease; Multideterminant nature of most other causes of excess mortality in Aboriginal people; Health status of Aborigines in the Northern Territory.

Skin, kidney and liver samples were investigated from 103 people with evidence of alcohol abuse at forensic autopsy. The diagnosis of alcohol abuse was based on clinical history, post mortem blood alcohol level and liver pathology. The findings confirmed the frequent widespread vascular IgA deposition in individuals with evidence of alcohol abuse. The frequency of IgA deposition in superficial small vessels of the dermis was not significantly different between individuals with IgA nephritis (16/85) and without such pathology (7/38). Based on these results, it can be inferred that had a pre-mortem skin biopsy been performed, it would not have had clinical usefulness in predicting the renal disease. [ABSTRACT FROM AUTHOR]

The goal of "closing the gap" in life expectancy between Indigenous and non-Indigenous people by 2030 is probably unattainable. Despite our best efforts, it is implausible that, within 21 years, preventive strategies, social or medical, will extinguish all excess expression and risk of chronic disease, the greatest contributor to excess Indigenous deaths. Developing systems to supply optimal primary care, as we currently know it, will take time. In addition, we have an incomplete understanding of the nature of excess risk, and lack remedies to totally contain it. Furthermore, vertical imprinting of excess risk will take some generations to ameliorate. To avoid failure by specifying unattainable goals, emphasis should be given to process measures that will lead to better outcomes. It is self-evident that sustained change requires better education, nutrition, employment opportunities and infrastructure. Within the health system, access to good quality, integrated primary care, needs-based health services funding, and an urgent and intensified focus on areas with the highest mortality rates, are top priorities. [ABSTRACT FROM AUTHOR]

This study investigated the induction of alcohol abuse related IgA glomerulonephritis in mice, a disease we have previously described in humans and in rats with noncirrhotic alcoholic liver disease. A commercial liquid diet was fed ad libitum to 115 mice from three strains: C57BL/6J, BALB/cJ, and C3H/HeJ. Animals were divided into two groups: 60 received 30% of their caloric intake as ethanol-alcoholized; and 55 were fed the same calorie count in the form of glucose-controls. Mice were killed at weekly intervals after 4 to 10 weeks of liquid diet ingestion. No diagnostic renal pathology was observed. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Genetic Researche in Indigenous Health: Significant Progress, Substantial Challenges," by E. E. Jowal in the 2012 issue.

A letter to the editor is presented in response to the article "Research, Information and Consent for the Australian Health Survey: A Separate Standard for Indigenous People?" by Wendy E. Hoy in the May 16, 2011 issue.

The author reflects on the Australian Health Survey (AHS) 2011-2013. She notes the exclusion of the Indigenous people under the age of 18 from direct clinical measurements and laboratory tests in the succeeding AHS. She also reports the discrimination of Indigenous people from donating blood and urine samples to a national repository. She believes that these exclusions will become precedents and deprive the Indigenous and medical communities to improve health profiles and outcomes.

Two letters to the editor are presented in response to the article "Patterns of Mortality in Indigenous Adults in the Northern Territory, 1988-2003," by Karen Andreasyan and Wendy Hoy, published in the May 2009 issue.

The article discusses a study on the incidence of mental disorders due to substance abuse and cardiovascular disease (CVD) among Aboriginal adults in a remote Indigenous community in the Australian Northern Territory. A population-based renal disease screening program has been performed during the research period between 1992 and 1995. After the adjustment of potential confounders the study confirmed the link between CVD and substance use-related mental disorders in the population concerned.

The prevalence of glomerulomegaly has been well documented in Australian Aborigines and a number of other indigenous populations. Correlations between glomerular size and focal and segmental glomerulosclerosis (FSGS) have been described in various animal models as well as in human studies. The aim of this study was to determine if a relationship existed between glomerular volume and the severity of FSGS in biopsies from Australian Aboriginals in the Northern Territory and Aboriginal inhabitants of the Tiwi Islands (Bathurst Island and Melville Island, Northern Territory, Australia). Consecutive clinical biopsies were obtained from 78 non-Tiwi and 72 Tiwi Aboriginals. Glomerular volume was estimated using the stereological method of Weibel and Gomez (1962). FSGS was graded from 0 to 4, with 0 being no sclerosis and 4 being severe sclerosis. A biphasic relationship between glomerular size and the severity of FSGS was identified. As the severity of FSGS increased from grade 0 to grade 3, glomerular size also increased. For both populations studied, glomeruli scored as grade 1, 2 and 3 were approximately 50% (p < 0.001), 65% (p < 0.001) and 100% (p < 0.001) larger than normal glomeruli, respectively. However, in glomeruli with grade 4 FSGS, glomerular size decreased to the size of normal glomeruli. These results indicate a strong association between the severity of FSGS and glomerular size in Australian Aborigines. [ABSTRACT FROM AUTHOR]

End-stage renal disease (ESRD) is a major health issue for Australian Aborigines. Abnormal glomerular hypertrophy (glomerulomegaly) may be an important predisposing factor for ESRD. The pathogenesis of glomerulomegaly remains unknown, but it may represent a compensatory hypertrophic response to decreased nephron endowment. The present study evaluated a physical disector/smooth fractionator combination for estimating glomerular number in human kidneys. Triplicate estimates of glomerular number and size were obtained for four kidneys. In brief, kidneys were cut approximately in half and the weights of the two resulting pieces recorded. The sampled ‘half’ was sliced into 4mm slices and every 4[sup th] slice was sampled. These slices were then cut into 5mm strips, which were further divided into 1.5mm blocks of approximately equal size. Every 25[sup th] block was processed to resin and exhaustively sectioned at 20µm with every 10[sup th] and 11[sup th] being sampled. Finally, sampled sections were used for estimating total glomerular number and glomerular volume with physical disectors. In calculating total glomerular number the first two fractions were based on weights. Estimates of total glomerular number for the four kidneys ranged from 364,161 to 586,094. The coefficients of variation based on three samples for each kidney were 12.5%, 20.7%, 9.2% and 10.4%. These results indicate that this method provides accurate and reproducible estimates of total glomerular number in human kidneys. This technique will be employed in future studies to determine if there is a difference in total glomerular between Australian Aborigines and Australian Caucasians, and between African and Caucasian Americans. [ABSTRACT FROM AUTHOR]

To compare body size measurements in Australian Aboriginals living in three remote communities in the Northern Territory of Australia with those of the general Australian population. Height, weight, waist and hip circumferences and derivative values of body mass index (BMI), waist-hip ratio (WHR), waist-height ratio (WHT), and waist-weight ratios (WWT) of adult Aboriginal volunteers (n = 814), aged 25 to 74 years were compared with participants in the nationally representative 'AusDiab' survey (n = 10,434). The Aboriginal body habitus profiles differed considerably from the Australian profile. When compared to Australian females, Aboriginal females were taller and had lower hip circumference but had higher WC, WHR, WHT, and WWT (P < 0.01 for all). When compared with their Australian counterparts, Aboriginal males were shorter, had lower body weight, WC, hip circumference, BMI, and WHT but had higher WHR and WWT (P < 0.001 for all). Significantly more Aboriginal females were classified as overweight and or obese using cutoffs defined by WC and by WHR than by BMI. Aboriginal males were less often overweight and/or obese by BMI than their counterparts, but were significantly more often overweight or obese by WHR. There were significant variations in body size profiles between Aboriginal communities. However, the theme of excess waist measurements relative to their weight was uniform. Aboriginal people had preferential central fat deposition in relation to their overall weight. BMI significantly underestimated overweight and obesity as assessed by waist measurements among Aboriginals. This relationship of preferential central fat deposition to the current epidemic of chronic diseases needs to be explored further.