ARDAC (Antecedents of Renal Disease in Aboriginal Children) Follow-up Study

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Indigenous people world-wide have higher rates of kidney failure than non-Indigenous people. Aboriginal Australians have the highest rates of kidney failure in the world, especially in those living in remote areas. The reasons for this are complex, and include well-known environmental risk factors that contribute to many diseases in Aboriginal people - socio-economic disadvantage, higher rates of infection, smoking, alcohol abuse and poor nutrition. There are also biological risk factors more specific to kidney disease such as low birth weight babies, reduced kidney volume, female sex, family history of kidney disease, genetic influences, over and under-nutrition and high blood pressure. Many of these risks may take effect in childhood, resulting in silent kidney damage that may become chronic in adulthood when diabetes and other influences take effect. In order to clarify the degree of risk early influences have on Aboriginal kidney disease before adult confounders complicate the picture, a unique study of early signs of kidney disease in outwardly healthy Aboriginal children was planned. These school children come from different locations across NSW, and have a non-Aboriginal comparator group. The first primary aims are complete: To determine: 1. Rates of blood and protein in the urine, and high blood pressure in Aboriginal as compared to non-Aboriginal children. These are the early markers, or antecedents of kidney disease; 2. If these antecedents differ over urban, coastal, rural and remote regions, and socio-economic areas; 3. Any association between antecedents and other risk factors such as age, gender, birth weight and growth; Secondary aims are currently underway: To determine: 1. The natural history of these antecedents of kidney disease by following these children for a further 4 years; 2. Which risk factors are more likely in children with persisting antecedents -ie the children more likely to develop serious kidney disease.