Chronic kidney disease (CKD) is affecting an increasing number of Australians. Despite being a highly preventable condition, one in three Australians are at risk of developing CKD. People are often unaware of the dangers of CKD and it can remain undiagnosed until the majority of kidney function is lost and damage is irreversible.
Research has shown that Aboriginal Australians are up to ten times more likely to suffer from chronic kidney disease. They are also diagnosed with kidney disease on average 12 years younger than non-Aboriginal Australians. The ARDAC study hopes to find some of the answers about why Aboriginal Australians experience such high rates of CKD. This information can then be used by communities to develop ways to prevent or slow the development of kidney disease, heart disease and diabetes. The findings can also be used to inform public health policy.
The earlier onset of kidney disease in Aboriginal people historically has been thought to be related to prenatal factors resulting in small babies with small kidneys.
Phases of the Study
Phase 1 of the ARDAC study (2002-2007) recruited a total of 2267 participants, and found at final follow up that the risk factors blood and/or protein in the urine and high blood pressure occurred in about 2% of children while 5% were obese. However there were no differences between Aboriginal and non-Aboriginal children after adjusting for geographical remoteness and social disadvantage. These results suggest that there is no increased risk for kidney disease in Aboriginal compared with non-Aboriginal Primary School children and suggests factors increasing the risk of chronic kidney disease in Aboriginal people are not established in childhood. These results meant we needed to continue the study and follow our participants into adolescents to identify the risk factors for kidney and heart disease and diabetes to support our communities maintain the health of their young people and prevent chronic disease in our people. The study continued into Phase 2 as there was limited data in Aboriginal young people as to when lifestyle changes become significant for Aboriginal health.
The second phase (2008-2013) recruited a further 1235 participants and also followed up the original participants from phase 1. At the end of this period, analysis of the data revealed some differences in risk factor profiles between groups beginning to appear, especially among Aboriginal girls in whom overweight and obesity was more prevalent. This is a preventable risk factor for kidney and heart disease, and diabetes. Monitoring the risk factors associated with these chronic diseases in the ARDAC participants as they move from adolescence into adulthood may be the key to finding the answers to prevention of these conditions.
The third phase (2014- current) replenished the cohort with another 256 participants to bring the total participation to 3758 young people. Follow up is still in progress and the results of this phase will be analysed and made available to partnering communities. The results will build on the current knowledge and provide more evidence to determine 'what' risk factors are contributing most to the high incidence of kidney and heart disease and diabetes in Aboriginal adults, and 'when' these are developing so preventative programs can be introduced. During this phase a survey measuring the socioeconomic determinants of health was initiated. Questions covering education, employment, housing, income, lifestyle, and family health history are covered. Associations between the socio-economic geographic determinants and participants biomedical data will contribute to the evidence-base for what factors adversely influence health outcomes.
These data will be available to inform local preventative strategies, developed in collaboration with the Aboriginal Community Controlled Health Services.