The Central Australian Aboriginal Renal Disease Registry

Summary: The Central Australian Aborigines (CAA) have a very high incidence of renal disease, up to 10 times more than other Australians in certain cohort groups. the mean age of CAA with end-stage chronic renal failure (CRF) is 10 years younger than others and the mortality rate due to CRF is higher across all age groups. the aetiology of this high incidence of renal disease remains unclear as no organized study has been undertaken so far. Hence a Renal Disease Registry was initiated with the main purpose of setting up a database in order to determine the relative incidence, aetiology and natural history of different types of renal disease in CAA. In addition, the Registry would also be used in the recall and follow-up of patients to facilitate better management in an attempt to retard the progression of CRF. Analysis of the data collected since 1987 shows that the incidence of end-stage CRF among CAA has doubled every 3 years. the pattern of renal diseases observed indicates that the CAA form a distinct group with several peculiarities. Some diseases such as membranous nephropathy and adult polycystic kidney disease are extremely rare while other diseases such as amyloidosis are seen more often. A type of non-immune complex disease, characterized by marked glomerulomegaly and indices of progressive nephron loss of uncertain aetiology, appears to be unique to this group. the deterioration of renal function in some diseases such as diabetic nephropathy is much more rapid than observed elsewhere. Comorbidities such as hypertension, obesity, malnutrition and intercurrent infections are common and appear to contribute to the rapid deterioration of CRF. Continued collection of prospective data over the next few years should yield valuable information and lead to improved strategies towards prevention and management of renal disease in CAA.     

Renal function and cardiovascular risk markers in a remote Australian Aboriginal community.

BACKGROUND: Australian Aborigines living in remote areas have exceedingly high rates of renal failure together with increased cardiovascular morbidity and mortality. To examine the basis of this association, we studied markers of renal function and cardiovascular (CV) risk in a coastal Aboriginal community in a remote area of the Northern Territory of Australia. End-stage renal disease (ESRD) incidence rates in that community are 15 times the national non-Aboriginal rate and CV mortality rates in the region are increased 5-fold. METHODS: A cross-sectional community survey was conducted. Markers of early renal disease examined included urine albumin/creatinine ratio (ACR), serum creatinine concentration and calculated glomerular filtration rate (GFR). CV risk markers included blood pressure as well as measures of glycaemia, diabetes and serum lipids. RESULTS: The study group included 237 people, 58% of the adult population of the community. The crude prevalence of microalbuminuria (urine ACR: 3.4-33.9 g/mol, 30-299 mg/g) was 31% and of overt albuminuria (urine ACR: >or=34 g/mol, >or=300 mg/g), 13%. The prevalence of overt albuminuria increased with age, but the prevalence of microalbuminuria was greatest in the 45-54 year age group. Microalbuminuria was associated with increasing body mass index, whereas overt albuminuria was associated with increasing glycated haemoglobin (HbA1c) and systolic blood pressure and a history of diabetes. The prevalence of elevated serum creatinine concentration (>or=120 micromol/l) was 10%. GFR (calculated using the MDRD equation) was <60 ml/min/1.73 m(2) in 12% and 60-79 ml/min/1.73 m(2) in a further 36% of the study population. Although many people with albuminuria had well preserved GFRs, mean GFR was lower in people with higher levels of albuminuria. CONCLUSIONS: The high prevalence of markers of renal disease in this community was consistent with their high rates of ESRD. The distribution of microalbuminuria suggested a 'cohort effect', representing a group who will progress to overt albuminuria. The powerful association of renal disease markers with CV risk factors confirms a strong link between renal and CV disease in the early, asymptomatic stages of each. Thus, pathologic albuminuria, in part, might be a manifestation of the metabolic/haemodynamic syndrome and both conditions might arise out of a common menu of risk factors. Hence, a single agenda of primary and secondary intervention may benefit both.     

Renal disease in the Australian Aboriginal population: A pathological study

Summary: End-stage renal failure and clinical evidence of renal disease are more frequent in Australian Aboriginals than in the non-Aboriginal Australian population. to investigate the lesions responsible for this excess a systematic study of renal biopsy findings in a series of Aboriginal patients in South Australia and the Northern Territory was performed and the data on these patients were compared with a consecutive series of renal biopsy findings in non-Aboriginal patients. Histological and morphometric comparison was made between biopsies from 206 Aboriginal and 690 non-Aboriginal patients. the distribution of glomerular lesions was found to differ significantly between the Aboriginal and non-Aboriginal groups: diabetic glomerulosclerosis, idiopathic glomerular enlargement (glomerulomegaly), mesangiocapillary glomeru-lonephritis (MCGN), and non-IgA mesangiopathic glomerulonephritis (GN) were found more frequently in the Aboriginal population, whereas there were fewer than expected examples of thin membrane nephropathy, minimal change disease and membranous GN. Diabetic glomerulosclerosis was significantly more frequent, and the lesions more severe, in Central Australia (where diabetes is more prevalent) and glomerulomegaly was especially common in Bathurst Island. These two conditions accounted for one third of the series and evidence is presented to suggest that a substantial proportion of renal disease in Aboriginals may be the consequence of conversion to a Western life style. of the 206 Aboriginal patients, 23 presented with chronic renal failure, suggesting either late presentation or unusually aggressive renal lesions, and 10 had end-stage renal disease on biopsy.     

Renal disease and the environment: lessons from Aboriginal Australia*

Aborigines in remote Australia are living in profound socio‐economic disadvantage and epidemiological transition. They are also experiencing an epidemic of cardiovascular disease, with deaths increased > threefold and renal failure increased > 20‐fold. Dialysis costs pose a crisis, but premature death is the greater human catastrophe. In one high‐risk group, we identified renal disease through the urinary albumin/creatinine ratio and assessed it distribution, its correlations, its associations with other morbidities and overall mortality and its natural history. We later introduced systematic antihypertensive and renal‐protective treatment for afflicted persons. Albuminuria was detected in 55% of adults. It was inversely correlated with glomerular filtration rate (GFR) and generally progressed over time. It was strongly correlated with cardiovascular risk, and its intensity predicted not only renal failure but also all‐cause natural death. Factors correlated with renal disease included increasing age, low birthweight and infant malnutrition, adult weight gain and its syndrome X metabolic accompaniments, skin infections, post‐streptococcal glomerulonephritis, heavy drinking, multiparity and a family history of renal disease. Nephron endowment probably also influences risk, with birthweight being one important driving force. Ironically, improved health services have probably contributed to the epidemic of renal failure in at least two ways: increased survival of low‐birthweight infants and increased longevity in adults, allowing the full progression or renal disease to its terminal state. The treatment programme was associated with swift and massive reductions in end‐stage renal failure, overall mortality and costs. Renal disease is multideterminant, with the simultaneous operation of several risk factors amplifying the increase in albuminuria and decrease in GFR that accompany increasing age. While many risk factors and mechanisms remain to be identified, our findings provide ample grounds for immediate intervention in similarly afflicted communities, with expectation of excellent outcome. Improved services will probably result in additional ascertainment of disease and more opportunity for its expression, so that disease prevention and modification become even more pressing obligations. Major shifts in our political, social, academic and clinical priorities are needed to effectively address these issues for all Aboriginal communities.     

Towards an epidemiologic definition of renal disease: Rates and associations of albuminuria in a high-risk Australian Aboriginal community

Summary: An epidemic of renal failure is accompanying the rising rates of hypertension, type 2 diabetes and cardiovascular disease among Aborigines in the Northern Territory of Australia. the rates and associations of the underlying renal disease were studied in a remote Aboriginal community whose renal failure rates are among the highest reported in the world. More than 90% of school-age children and adults participated in a health screen, in which the urinary albumin/creatinine ratio (ACR) was used as the primary renal disease marker. Albuminuria was evident in early childhood and increased dramatically with age; 26% of adults had microalbuminuria and 24% had overt albuminuria. Most hypertension segregated in persons with albuminuria and all renal failure developed out of a background of overt albuminuria. ACR levels correlated with the presence of scabies at screening, with a history of post-streptococcal glomerulonephritis, with increasing bodyweight or its surrogates, with increasing blood pressure, glucose, insulin and lipid levels, and with evidence of heavy drinking. ACR also correlated inversely with birthweight. Finally, increasing ACR correlated with an increasing cardiovascular risk factor score. Thus many factors contribute to renal disease in this community; most are the features and consequences of lifestyle change, poverty and disadvantage. Renal disease shares risk factors, including low birthweight, with Syndrome X, which supports the inclusion of renal disease in that syndrome, and explains the excess cardiovascular morbidity in people with chronic renal disease. There is an urgent need for effective programs to modify recognized risk factors, and to identify and treat people with established renal disease to retard the progression of renal insufficiency.     

Glomerular size and glomerulosclerosis in Australian Aborigines

Background: An epidemic of end‐stage renal disease is occurring in Aboriginal people. Post streptococcal glomerulonephritis (PSGN) associated with pyoderma, occurs frequently in Aboriginal children, although it is virtually eliminated in the rest of Australia. We examined the association between PSGN in childhood and the development of chronic renal disease in later life. Methods: In a remote coastal community in the Northern Territory, we established a historical cohort of children who were aged 2‐15 years during epidemic PSGN in 1980 and 1987. History of PSGN during the epidemics was defined using clinical criteria from the original medical records. a) PSGN: haematuria/proteinuria plus oedema or hypertension n = 63 b) haematuria or proteinuria only n = 87, and c) controls: normal examination and urinalysis n = 89, or normal examination without urinalysis n = 135 or not seen n = 98. The main outcome measure, urine albumin to creatinine ratio ACR, was measured in these people at a mean time of 14 years after the epidemics and at a mean age of 20 yrs, range 8‐33. Results: Proportions with albuminuria at follow‐up.

UROLITHIASIS IN AUSTRALIAN ABORIGINAL CHILDREN

Thirty-six Australian Aboriginal children with urolithiasis were reviewed. Males dominated the series. The age distribution ranged from 8 months to 12 years and nearly 70% were 2 years or younger. Thirty-five patients had upper tract stones. Ultrasound was diagnostic in 35 patients and was falsely negative in one. Dietary factors, dehydration and recurrent diarrhoea are incriminated in the aetiology, because ammonium urate and oxalate were the main constituents of the stones. Malformations of the urinary tract were rare and known metabolic disorders were not seen. Chemical dissolution of the stones was found to be a safe and effective adjuvant in the management of urate stones.     

Deprivation and dialysis: pathways to kidney failure in Australian Aborigines

Rates of end-stage renal disease among Australian Aboriginal people have been increasing over the past 2 decades, particularly in the northern and more remote areas of Australia, and especially in disadvantaged communities. Proteinuria predicts the rate of loss of kidney function; it is common in young adults and virtually universal in those over 50 years of age. Cumulative independent risk factors include low birth weight, recurrent skin infections, adult obesity, diabetes or its precursors, smoking, excessive alcohol intake, and a family history of renal disease. A plausible theory is that intrauterine malnutrition permanently reduces total nephron numbers, which are then overworked in adulthood by the metabolic stresses of obesity (from excess alcohol and poor diet), by higher blood pressures, and by infections, while starved of blood supply because of smoking. Although kidney disease is often only detected when already well established, active medical intervention offers great rewards. Control of blood pressure (preferentially using angiotensin-converting enzyme (ACE) inhibitors and angiotensin-II receptor blockers (AIIRBs) in combination) can often stop or even reverse kidney damage, even if ongoing diabetes control is poor. Adequately funded kidney health programs with active Aboriginal health worker involvement are enormously cost-effective: tight blood pressure control at least halves the rate of disease progression, and every year of dialysis deferred for 1 patient could fund the appointment of 2 health workers. Addressing the underlying social causes for this epidemic is critical.     

Renal trauma in Australian rules football: an institutional experience

BACKGROUND: Australian rules football is the most popular team sport in Australia. Literature on severe abdominal injuries in this sport is limited. The present study aims to review cases of renal trauma in Australian football at our institution. METHODS: A retrospective study was performed. All men admitted to our institution with renal trauma or haematuria associated with Australian football from July 1995 to July 2001 were analysed. RESULTS: There were 13 cases of renal trauma; two were grade V injuries requiring nephrectomy. CONCLUSION: Renal injury will be intermittently encountered owing to the popularity of Australian football. Renal injuries are often difficult to assess and early recognition, management and referral to a district hospital is crucial.     

MMPI-2 Data for Australian Vietnam Veterans with Combat-Related PTSD

Considerable attention has been devoted to the MM PI in the assessment of combat-related PTSD. To date, published data have focused almost exclusively on American Vietnam veterans. This study investigated MMPI-2 profiles of 100 Australian Vietnam veterans admitted to an intensive PTSD treatment program. Comparisons with United States (U.S.) data suggested strong similarities between the American and Australian populations in terms of F-scale elevations and typical 3-point code types (8-7-2). However, the American samples showed relatively higher elevations of Scales 4 and 6, suggesting social alienation and a tendency to externalize, while a subgroup of Australian veterans showed a greater propensity for somatization (Scale 1). The results provide overall support for the generalizability of American MMPI data to an alternative cultural group of combat veterans.     

Treatment of Australian Aboriginals with end-stage renal disease in the top end of the Northern Territory: 1978–93

Summary: We describe the treatment of Australian Aboriginals with end-stage renal disease (ESRD) in the Top End of the Northern Territory from 1978 to 1993. Eighty-three Aboriginals and 44 non-Aboriginals were accepted into the programme. the average annual incidence of ESRD for Aboriginals in 1988–93 was 440 per million (pm), or 17.4 times that of non-Aboriginals. Aboriginals were 20 to 30 years younger than non-Aboriginals at start of treatment, and there was an excess of females, in contrast with a male excess among non-Aboriginals. Aboriginals had a higher proportion of ESRD attributed to glomerulonephritis and to diabetes, and 5% had amyloid associated with chronic infections. Most Aboriginals with ESRD received haemodialysis, and a few received peritoneal dialysis. Only 23% received transplants, compared with 48% of non-Aboriginals, and graft and patient survival after transplant was poor for Aboriginals. A sequence of non-compliance, chronic rejection, intensified immunosuppression and exacerbated co-morbidities was a common cause of death. Many Aboriginals with ESRD had serious co-morbidities, especially chronic infections and alcohol abuse; these frequently precluded transplant and were often the ultimate cause of death. Withdrawal from treatment was the cause of death in 23% of Aboriginals, compared to only 6% of non-Aboriginals, and usually reflected poor tolerance of, and compliance with, treatment and a lack of social support. High rates of albuminuria and clinical nephropathy in Aboriginals are compatible with their high ESRD rates. End stage renal disease treatment choices and outcomes are related largely to their profoundly inferior health status and socioeconomic deprivation. A 2.5-fold increase in ESRD among Aboriginals is projected by the year 2000. Precursors of ESRD must be studied, and screening and renoprotective treatment introduced, along with intensified efforts to improve the health and welfare of the entire Aboriginal population.     

Reduced nephron number and glomerulomegaly in Australian Aborigines: a group at high risk for renal disease and hypertension

Aborigines in remote areas of Australia have much higher rates of renal disease, as well as hypertension and cardiovascular disease, than non-Aboriginal Australians. We compared kidney findings in Aboriginal and non-Aboriginal people in one remote region. Glomerular number and mean glomerular volume were estimated with the disector/fractionator combination in the right kidney of 19 Aborigines and 24 non-Aboriginal people undergoing forensic autopsy for sudden or unexpected death in the Top End of the Northern Territory. Aborigines had 30% fewer glomeruli than non-Aborigines--202,000 fewer glomeruli per kidney, or an estimated 404,000 fewer per person (P=0.036). Their mean glomerular volume was 27% larger (P=0.016). Glomerular number was significantly correlated with adult height, inferring a relationship with birthweight, which, on average, is much lower in Aboriginal than non-Aboriginal people. Aboriginal people with a history of hypertension had 30% fewer glomeruli than those without--250,000 fewer per kidney (P=0.03), or 500,000 fewer per person, and their mean glomerular volume was about 25% larger. The lower nephron number in Aboriginal people is compatible with their susceptibility to renal failure. The additional nephron deficit associated with hypertension is compatible with other reports. Lower nephron numbers are probably due in part to reduced nephron endowment, which is related to a suboptimal intrauterine environment. Compensatory glomerular hypertrophy in people with fewer nephrons, while minimizing loss of total filtering surface area, might be exacerbating nephron loss. Optimization of fetal growth should ultimately reduce the florid epidemic of renal disease, hypertension, and cardiovascular disease.     

Antecedents of renal disease in Aborigines

SUMMARY:   Rates of end-stage renal disease in the Aboriginal community have been increasing over the past two decades, particularly in the northern and more remote areas of Australia, and especially in disadvantaged communities.
Proteinuria predicts the rate of loss of renal function and is common in young adults and virtually universal in those over 50 years old. Cumulative independent risk factors include low birthweight, recurrent skin infections, adult obesity, diabetes or its precursors, smoking, excessive alcohol intake and a family history of renal disease. A plausible theory is that intrauterine malnutrition permanently reduces total nephron numbers, which are then overworked in adulthood by the metabolic stresses of obesity (from excess alcohol and poor diet), blood pressure and infections, while starved of blood supply through smoking.
Although renal disease is often only detected when already established, there are great rewards for active medical intervention. Control of blood pressure (preferentially using angiotensin-converting enzyme (ACE) inhibitors and angiotensin-II receptor blockers (AIIRB) in combination) can often stop or even reverse kidney damage, despite ongoing poor diabetic control. Adequately funded kidney health programmes with active Aboriginal Health Worker involvement are enormously cost-effective: tight blood pressure control at least halves the rate of disease progression, and every year of dialysis deferred for one patient could fund the appointment of two more health workers. Addressing the underlying social causes for this epidemic is critical.     

The natural history of renal disease in Australian Aborigines. Part 2. Albuminuria predicts natural death and renal failure.

BACKGROUND: The purpose of this study was to describe the relationship of albuminuria and glomerular filtration rate (GFR) with natural death and renal failure in an Australian Aboriginal community with high rates of renal disease. METHODS: Study subjects were 825 adults (18+ years, mean 33.6 years) or 88% of adults in a remote community who participated in a health screening program offered between 1990 and 1997. The urinary albumin:creatinine ratio (ACR; g/mol) was used as the renal disease marker. Participants were followed for 1.0 to 9.8 years (mean 5.8 years) until renal failure, death, the start of systematic antihypertensive/renal-protective treatment or June 30, 2000. RESULTS: Sixty-five people reached a terminal end point of renal failure or natural death. Sixteen people developed terminal renal failure, all of whom had an ACR of 34+ at baseline exam. There were 49 other natural deaths, which were also strongly correlated with increasing ACR and decreasing GFR over a wide range. This was observed in people without diabetes and in people with normal and elevated blood pressures. It applied to deaths associated with cardiovascular disease and to deaths without an assigned primary or underlying cardiovascular or renal cause. With adjustment for age, the association with death was more robust with ACR than GFR. When compared with people with an ACR <3.4, the hazard ratio (HR; 95% CI) for nonrenal natural death of persons with an ACR 3.4 to 33 was 3.0 (1.1 to 8.4), with an ACR 34 to 99, it was 5.4 (1.8 to 15.9), and with an ACR 100+, it was 6.5 (2.0 to 21). Regression equations predicted that each tenfold increase in the ACR was associated with a 3.7-fold increase in all-cause natural death: a> 400-fold increase in renal deaths, a 4-fold increase in cardiovascular deaths, and a 2.2-fold increase in nonrenal noncardiovascular deaths. Eighty-four percent of all-cause natural death was associated with pathologic albuminuria. CONCLUSION: All renal failure develops out of a background of persistent albuminuria in this population. More important, albuminuria and, inversely, GFR are powerful markers of risk for nonrenal natural death, including, but not restricted to, cardiovascular deaths. Most of the risk for premature death can be assessed by a simple urine test, and interventions that prevent development and progression of albuminuria and loss of GFR should not only prevent renal insufficiency, but powerfully reduce mortality from natural causes as well.     

The natural history of renal disease in Australian Aborigines. Part 1. Changes in albuminuria and glomerular filtration rate over time.

BACKGROUND: The purpose of this study was to describe changes over time in albuminuria and glomerular filtration rate (GFR) in a cohort of Australian Aborigines from a community with high rates of renal disease and renal failure. METHODS: Participants were 486 adult community members (20+ years at first exam) who were screened for renal disease and related factors on at least two occasions (mean 2.7 occasions), at least a year apart, between 1990 and 1997. Renal function was assessed by the albumin:creatinine ratio (ACR; g/mol) on a random urine specimen and by the GFR estimated from the Cockcroft-Gault formula. Evolution over time was expressed as the average annual changes in these parameters. RESULTS: On baseline examination, 70% of participants had albuminuria (ACR 1.1+ g/mol) There was a significant net increase in ACR and a fall in GFR in the cohort over time. Among individuals, however, changes were strongly correlated with ACR levels at baseline. There was no loss of GFR in persons with normal renal parameters at baseline and a rapid loss of GFR in those with substantial levels of albuminuria at baseline. Other factors significantly correlated with progression of ACR included age, baseline body mass index and systolic blood pressure, the presence of diabetes (or levels of fasting glucose), and elevated levels of serum gamma glutamyl transferase. Factors significantly associated with loss of GFR included body mass index, diabetes, systolic and diastolic blood pressures, microscopic hematuria, and marginally high cholesterol levels. CONCLUSION: Albuminuria progresses and GFR is lost over time in individuals in this community, at rates that are strongly dependent on levels of pre-existing albuminuria. Much loss of GFR and all renal failure should be avoided by preventing the development of albuminuria and minimizing its progression. This depends on improving the weight, blood pressure, and metabolic profile of the entire community and reducing infections. Modification of the course in people with established disease depends on vigorous control of blood pressure and the metabolic profile and the specific use of angiotensin-converting enzyme inhibitors.     

Epidemiology of renal and cardiovascular risk factors in Toba Aborigines

OBJECTIVES: To detect, educate, and control cardiovascular (CVD) risk factors, diabetes mellitus, hypertension, obesity, central obesity, and renal damage markers such as glomerular filtration rate (GFR) and proteinuria within a population of Toba aborigine people who live in the outskirts of Resistencia city, Chaco Province, Argentina. METHODS: A sample was selected from four Toba communities. Blood and urine samples were drawn in their own homes. Proteinuria was considered positive when a urinary protein/urinary creatinine rate (uPr/uCr) > or = 0.20. GFR was estimated by Levy formula, and the stages of chronic kidney disease (CKD) were as defined in the National Kidney Foundation Guidelines. RESULTS: In all, 385 subjects were included, 36% males, mean age = 36.1 years old. The prevalence of CVD risk factors was as follows: hypertension in 97 (25.2%), proteinuria in 84 (21.8%), CKD in 93 (24.2%) [Stage 1 in 26 (6.8%), Stage 2 in 46 (12%), and Stage 3 in 21 (5.5%)]. No subjects showed CKD Stage 4 or 5. Being overweight was found in 129 (33.5%), obesity in 82 (21.3%), central obesity in 190 (49.4%), and diabetes in 8 (2.1%). The presence of CKD was associated with an increased prevalence in central obesity, hypertension, and diabetes, but not obesity. The adjusted relative risk for proteinuria was 2.79 (p < or = 0.008) in subjects of at least 45 years of age, compared to subjects under 25 years. CONCLUSIONS: This group of aborigines showed a high prevalence of proteinuria and CVD risk factors and CKD not related to diabetes.     

Epidemiology of Renal and Cardiovascular Risk Factors in Toba Aborigines

Objectives. To detect, educate, and control cardiovascular (CVD) risk factors, diabetes mellitus, hypertension, obesity, central obesity, and renal damage markers such as glomerular filtration rate (GFR) and proteinuria within a population of Toba aborigine people who live in the outskirts of Resistencia city, Chaco Province, Argentina. Methods. A sample was selected from four Toba communities. Blood and urine samples were drawn in their own homes. Proteinuria was considered positive when a urinary protein/urinary creatinine rate (uPr/uCr) ≥ 0.20. GFR was estimated by Levy formula, and the stages of chronic kidney disease (CKD) were as defined in the National Kidney Foundation Guidelines. Results. In all, 385 subjects were included, 36% males, mean age = 36.1 years old. The prevalence of CVD risk factors was as follows: hypertension in 97 (25.2%), proteinuria in 84 (21.8%), CKD in 93 (24.2%) [Stage 1 in 26 (6.8%), Stage 2 in 46 (12%), and Stage 3 in 21 (5.5%)]. No subjects showed CKD Stage 4 or 5. Being overweight was found in 129 (33.5%), obesity in 82 (21.3%), central obesity in 190 (49.4%), and diabetes in 8 (2.1%). The presence of CKD was associated with an increased prevalence in central obesity, hypertension, and diabetes, but not obesity. The adjusted relative risk for proteinuria was 2.79 (p ≤ 0.008) in subjects of at least 45 years of age, compared to subjects under 25 years. Conclusions. This group of aborigines showed a high prevalence of proteinuria and CVD risk factors and CKD not related to diabetes.