Secondary Prevention of Renal and Cardiovascular Disease

Abstract

Abstract. Australian Aborigines are experiencing an epidemic of renal and cardiovascular disease. In late 1995 we introduced a treatment program into the Tiwi community, which has a three-to fivefold increase in death rates and a recent annual incidence of treated ESRD of 2760 per million. Eligible for treatment were people with hypertension, diabetics with micro or overt albuminuria, and all people with overt albuminuria. Treatment centered around use of perindopril (Coversyl, Servier), with other agents added to reach BP goals; attempts to control glucose and lipid levels; and health education. Thirty percent of the adult population, or 267 people, were enrolled, with a mean follow up of 3.39 yr. Clinical parameters were followed every 6 mo, and rates of terminal endpoints were compared with those of 327 historical controls matched for baseline disease severity, followed in the pretreatment program era. There was a dramatic reduction in BP in the treatment group, which was sustained through 3 yr of treatment. Albuminuria and GFR stabilized or improved. Rates of natural deaths were reduced by an estimated 50% (P ϭ 0.012); renal deaths were reduced by 57% (P ϭ 0.038); and nonrenal deaths by 46% (P ϭ 0.085).

Kidney and related chronic disease profiles and risk factors in three remote Australian Aboriginal communities

“…5,6 The number of people with overt albuminuria needed to treat (NNT) over a mean of 3.4 years to avoid 1 terminal event was only 9.5. 7,8 Subsequent events showed that continued systematic screening and treatment were needed to sustain the good effect. 9 In 1998, when primary care services in general and chronic-disease services in particular were still seriously inadequate in the NT, other communities expressed interest in a similar program.…”

Towards health equity through an adult health check for Aboriginal and Torres Strait Islander people

“…Preventive healthcare can both reduce costs to the health sector and enhance health equity for Aboriginal peoples and Torres Strait Islanders, as most of the factors underpinning health disparities relate to social disadvantage (Box). For example, if renal disease is detected early, end‐stage renal failure can be avoided and treatment will reduce mortality by 50% 12 . However, during 1997–2002, Aboriginal and Torres Strait Islander Australians (compared with non‐Indigenous Australians) were twice as likely to be referred late for dialysis treatment.…”

Blood pressure 2 years after a chronic disease management intervention study

“…However, before a similar observation was made by Hoy et al after a similar program was initiated for the Tiwi in Australia (28). In most communities the prevalence of people requiring dialysis is still rising (9).…”