- To assess the evolution of kidney disease in an Indigenous Australian cohort from the regions of Australia with the greatest burden of End Stage Kidney Disease
- To perform community consultation and design appropriate interventions to reduce progression of chronic kidney disease in Indigenous Australians.
The eGFR study is a longitudinal study of kidney damage in a cohort of 600 Indigenous Australians from across the Northern Territory (NT), Western Australia (WA) and Far North Queensland.
Phase 1 of the study (2008-2011) assessed the accuracy of estimated measures of kidney function in Indigenous Australians. Determining the accuracy of measures of eGFR in this population with a high burden of chronic kidney disease is particularly important both to underline the validity of other clinical research and to confirm or modify current clinical practice, because levels of kidney function correspond to pathophysiological changes which determine current clinical care pathways.
Phase 2 of the study (2012-2014) assesses progression of markers of kidney damage (urine protein and eGFR) in this high-risk cohort of Indigenous Australians. The latter part of Phase 2 will also involve design of interventions in collaboration with communities and service providers and based on our findings of key factors contributing to rapid progression of chronic kidney disease. Further funding will then be sought for these interventions (Phase 3).
Implications for policy and practice:
The incidence of end-stage kidney disease is 15 times higher among Indigenous Australians than it is in non-Indigenous Australians.
End stage kidney disease is the complete or almost complete failure of the kidneys to work, and more than 1,300 Indigenous Australians received treatment for this in 2008. Therefore, developing an accurate measure of kidney function is critical to improving the life span and health outcomes of those susceptible to kidney disease.
In addition, if we are to address the epidemic of kidney disease among Indigenous Australians, it is vital that we better understand the factors contributing to rapid progression of kidney disease in this population. This study will allow the rates of decline in glomerular filtration rate to be accurately documented in Indigenous Australians using standardised measurements. It should provide evidence for clinical guidelines in a field where evidence is currently lacking: factors contributing to rapid progression of kidney disease in Indigenous Australians. This would enable development of appropriate protocols for investigation and management of chronic kidney disease and subsequent improvements in clinical practice. It will also enable design of an appropriate and targeted intervention study to address individual-, health service and community-level interventions that aim to ameliorate the progression of kidney damage to end stage kidney disease.
Our research has found:
Phase 1 of this study validated the appropriateness of using a standard kidney function test for Indigenous Australians.
The standard kidney function test known as CKD-EPI eGFR, was found it to be an accurate and reliable test of kidney function in Indigenous Australians, similar to reports that it is accurate and reliable in non-Indigenous Australians.
The study allayed concerns that the difference in body builds between Indigenous and non-Indigenous Australians may make eGFR an inappropriate measure for Indigenous patients.
The positive results mean that health professionals can use the kidney function test nationwide with confidence, offering accurate tests for both Indigenous and non-Indigenous patients.
- Elizabeth Death
Phase two commenced in 2012 and will conclude in 2014.
- National Health and Medical Research Council (NHMRC).
- Austin Health
- University of Melbourne
- University of Queensland.
- Barr EL, Maple-Brown LJ, Barzi F, Hughes JT, Jerums G, Ekinci EI, Ellis AG, Jones GR, Lawton PD, Sajiv C, Majoni SW, Brown AD, Hoy WE, O'Dea K, Cass A, MacIsaac RJ. Comparison of creatinine and cystatin C based eGFR in the estimation of glomerular filtration rate in Indigenous Australians: The eGFR Study. Clinical Biochemistry 2016 Nov 25. pii: S0009-9120(16)30377-0 [Epub ahead of print]
- Hughes, Maple-Brown, Thomas, Lawton, Sinha, Cass, Barzi, Jones, Jerums, MacIsaac, O'Dea, Hoy. Cross-sectional associations of albuminuria among Aboriginal and Torres Strait Islander adults: the eGFR Study. Nephrology November 2016, doi: 10.1111/nep.12956
- Hughes JT, K O’Dea, K Piera, F Barzi, A Cass, WE Hoy, RJ MacIsaac, LJ Maple-Brown. Associations of serum adiponectin with markers of cardio-metabolic disease risk in Indigenous Australian adults with good health, diabetes and chronic kidney disease. Obes Res Clin Prac, 2016 Nov - Dec;10(6):659-672.
- Ekinci E, Hughes J, Chatfield M, Lawton PD, Jones GRD, Ellis A, Cass A, Thomas M, MacIsaac RJ, O'Dea K, Jerums G, Maple-Brown L. Hyperfiltration in Indigenous Australians with and without diabetes. Nephrology, Dialysis, Transplantation, 2015 Nov; 30(11):1877-84.
- Maple-Brown L, Hughes J, Chatfield M, Ward LC, Piers LS, Jones GD, Lawton P, Ellis AE, Cass A, Hoy W, O’Dea K, MacIsaac R, Jerums G. Adding Measures of Body Composition to the CKD-EPI GFR Estimating Equation in Indigenous Australians: The eGFR Study. American Journal of Kidney Diseases, 2015, Apr; 65(4):632-4.
- Maple-Brown LJ, Ekinci EI, Hughes JT, Chatfield M, Lawton PD, Jones GRD, et al. Performance of formulas for estimating Glomerular Filtration Rate in Indigenous Australians with and without Type 2 diabetes: The eGFR Study. Diabetic Medicine, 2014, 31(7):829-38.
- Maple-Brown LJ, Hughes JT, Lawton PD, Jones GR, Ellis AG, Drabsch K, Brown AD, Cass A, Hoy WE, Macisaac RJ, O'Dea K, Jerums G. Accurate Assessment of Kidney Function in Indigenous Australians: the eGFR Study. American Journal of Kidney Diseases, 2012; 60(4): 680-2.
- Maple-Brown L, P Lawton, J Hughes, SK Sharma, G Jones, A Ellis, W Hoy, A Cass, R MacIsaac, A Sinha, M Thomas, LS Piers, L Ward, K Drabsch, S Panagiotopoulos, R McDermott, K Warr, S Cherian, A Brown, G Jerums, K O’Dea. Study Protocol - Accurate assessment of kidney function in Indigenous Australians: aims and methods of the eGFR Study. BMC Public Health 2010; 10:80.
- Louise J Maple-Brown, Jaquelyne T Hughes, Rebecca Ritte, Federica Barzi, Wendy Hoy, Paul D Lawton, Graham RD Jones, Elizabeth Death, Alison Simmonds, Ashim Sinha, Sajiv Cherian, Mark AB Thomas, Robyn McDermott, Alex Brown, Kerin O’Dea, George Jerums, Alan Cass, Richard J MacIsaac. Progression of kidney disease in Indigenous Australians: The eGFR Follow-up Study. Clinical Journal of the American Society of Nephrology (CJASN), 2016 June 6;11(6):993-1004.
- Barr ELM, Barzi F, Hughes JT, Jerums G, O’Dea K, Brown A, Ekinci EI, Jones GRD, Lawton PD, Sinha A, Richard J MacIsaac RJ, Cass A, Maple-Brown LJ. The contribution of cardio-metabolic risk factors to estimated glomerular filtration rate (eGFR) decline in Indigenous Australians with and without albuminuria– the eGFR follow-up. Nephrology (accepted 14 May 2017).