1. ¹Centre for Kidney Research, The Children's Hospital at Westmead and The School of Public Health, University of Sydney, Sydney, Australia
2. ²Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
3. ³Department of Nephrology, The Children's Hospital at Westmead and Clinical Associate, The School of Public Health, University of Sydney, Sydney, Australia
4. ⁴Department of Nephrology, The Children's Hospital at Westmead, Sydney, Australia
5. ⁵Department of Rural Health, University of Sydney, Sydney, Australia
6. ⁶Department of Clinical Epidemiology, The School of Public Health, University of Sydney and Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia

Correspondence: L Haysom, Centre for Kidney Research, The Children's Hospital at Westmead, Locked Bag 4001, Westmead NSW 2145, Australia. E-mail: LeighH@chw.edu.au

Received 10 April 2006; Revised 15 November 2006; Accepted 5 December 2006; Published online 21 February 2007.

Abstract

Indigenous people suffer substantially more end-stage kidney disease (ESKD), especially Australian Aboriginals. Previous work suggests causal pathways beginning early in life. No studies have shown the prevalence of early markers of chronic kidney disease (CKD) in both Indigenous and non-Indigenous children or the association with environmental health determinants – geographic remoteness and socioeconomic disadvantage. Height, weight, blood pressure, and urinary abnormalities were measured in age- and gender-matched Aboriginal and non-Aboriginal children from elementary schools across diverse areas of New South Wales, Australia. Hematuria was defined as 25 red blood cells/l (1+), proteinuria 0.30 g/l (1+), and albuminuria (by albumin:creatinine) 3.4 mg/mmol. Remoteness and socioeconomic status were assigned using the Accessibility and Remoteness Index of Australia and Socio-Economic Indexes For Areas. From 2002 to 2004, 2266 children (55% Aboriginal, mean age 8.9 years) were enrolled from 37 elementary schools. Overall prevalence of hematuria was 5.5%, proteinuria 7.3%, and albuminuria 7.3%. Only baseline hematuria was more common in Aboriginal children (7.1 versus 3.6%; P=0.002). At 2-year follow-up, 1.2% of Aboriginal children had persistent hematuria that was no different from non-Aboriginal children (P=0.60). Socioeconomic disadvantage and geographical isolation were neither significant nor consistent risk factors for any marker of CKD. Aboriginal children have no increase in albuminuria, proteinuria, or persistent hematuria, which are more important markers for CKD. This suggests ESKD in Aboriginal people may be preventable during early adult life.