The excess incidence of diabetic end-stage renal disease among blacks. A population-based study of potential explanatory factors

F. L. Brancati, J. C. Whittle, P. K. Whelton, A. J. Seidler and M. J. Klag
Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Md 21287-6231.

OBJECTIVE--To investigate whether the excess incidence of diabetic end-stage renal disease (ESRD) among African Americans could be explained by racial differences in putative ESRD risk factors. DESIGN--Population-based, ecologic study using the 1981 and 1982 Maryland Statewide Household Hypertension Survey for data on risk factor prevalence. PARTICIPANTS--A total of 2.1 million adults residing within the boundaries of the Maryland Regional ESRD Registry, grouped by race and ZIP code into 26 subpopulations. MAIN OUTCOME MEASURE--Incidence rates of treatment for diabetic ESRD between 1980 and 1985 from the Maryland Regional ESRD Registry by subpopulation. RESULTS--Between 1980 and 1985, 442 persons entered treatment for diabetic ESRD. At the level of the subpopulation, diabetic ESRD incidence was positively associated with black race (relative risk [RR], 3.42; 95% confidence interval [CI], 2.84 to 4.13), prevalence of diabetes (RR, 2.35; 95% CI, 1.92 to 2.87), prevalence of poorly controlled hypertension (RR, 1.80; 95% CI, 1.45 to 1.86), lack of a regular source of health care (RR, 1.82; 95% CI, 1.62 to 2.05), and lower socioeconomic status as indicated by lack of college education (RR, 1.41; 95% CI, 1.32 to 1.52) (all, P < .0001). After adjusting for these risk factors, black race remained strongly associated with the overall incidence of diabetic ESRD (RR, 2.70; 95% CI, 1.89 to 3.86; P < .0001). Further analyses suggested that this excess risk among blacks was confined to ESRD related to non-insulin-dependent diabetes (RR, 4.80; 95% CI, 3.09 to 7.46; P < .0001); blacks were at no higher risk than were whites for ESRD related to insulin-dependent diabetes (RR, 0.90; 95% CI, 0.52 to 1.55; P = .70). CONCLUSIONS--These data suggest that the excess incidence of diabetic ESRD among blacks is not fully explained by a higher prevalence of diabetes or hypertension in blacks or by racial differences in age, socioeconomic status, or access to health care. Instead, they suggest an increased susceptibility to ESRD resulting from non-insulin-dependent diabetes among blacks as compared with whites.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Socioeconomic Status and Chronic Kidney Disease at Presentation to a Renal Service in the United Kingdom
Bello et al.
CJASN 2008;3:1316-1323.
ABSTRACT | FULL TEXT  

Ethnicity, age and incidence rates for renal replacement therapy (RRT) in Birmingham, UK: 1990-2004
Lambie et al.
Nephrol Dial Transplant 2008;0:gfn366v1-gfn366.
ABSTRACT | FULL TEXT  

Long-term Effects of Renin-Angiotensin System-Blocking Therapy and a Low Blood Pressure Goal on Progression of Hypertensive Chronic Kidney Disease in African Americans
Appel et al.
Arch Intern Med 2008;168:832-839.
ABSTRACT | FULL TEXT  

Chromogranin A Polymorphisms Are Associated With Hypertensive Renal Disease
Salem et al.
J. Am. Soc. Nephrol. 2008;19:600-614.
ABSTRACT | FULL TEXT  

Neighborhood Poverty and Racial Differences in ESRD Incidence
Volkova et al.
J. Am. Soc. Nephrol. 2008;19:356-364.
ABSTRACT | FULL TEXT  

Racial Differences in End-Stage Renal Disease Rates in HIV Infection versus Diabetes
Choi et al.
J. Am. Soc. Nephrol. 2007;18:2968-2974.
ABSTRACT | FULL TEXT  

Six-Year Incidence of Proteinuria in Type 1 Diabetic African Americans
Roy et al.
Diabetes Care 2007;30:1807-1812.
ABSTRACT | FULL TEXT  

Longitudinal Study of Racial and Ethnic Differences in Developing End-Stage Renal Disease among Aged Medicare Beneficiaries
Xue et al.
J. Am. Soc. Nephrol. 2007;18:1299-1306.
ABSTRACT | FULL TEXT  

Is augmentation index a good measure of vascular stiffness in the elderly?
Fantin et al.
Age Ageing 2007;36:43-48.
ABSTRACT | FULL TEXT  

Survival Advantage of Black Patients with Kidney Disease after Acute Myocardial Infarction
Newsome et al.
CJASN 2006;1:993-999.
ABSTRACT | FULL TEXT  

Racial Differences in the Prevalence of Chronic Kidney Disease among Participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort Study
McClellan et al.
J. Am. Soc. Nephrol. 2006;17:1710-1715.
ABSTRACT | FULL TEXT  

Hepatitis C Is a Predictor of Poorer Renal Survival in Diabetic Patients
Crook et al.
Diabetes Care 2005;28:2187-2191.
ABSTRACT | FULL TEXT  

Ethnic Differences in Mortality, End-Stage Complications, and Quality of Care Among Diabetic Patients: A review
Lanting et al.
Diabetes Care 2005;28:2280-2288.
ABSTRACT | FULL TEXT  

Mechanisms and Fetal Origins of Kidney Disease
Lackland
J. Am. Soc. Nephrol. 2005;16:2531-2532.
FULL TEXT  

Racial and Ethnic Differences in Microalbuminuria Prevalence in a Diabetes Population: The Pathways Study
Young et al.
J. Am. Soc. Nephrol. 2005;16:219-228.
ABSTRACT | FULL TEXT  

Racial Differences in the Progression from Chronic Renal Insufficiency to End-Stage Renal Disease in the United States
Hsu et al.
J. Am. Soc. Nephrol. 2003;14:2902-2907.
ABSTRACT | FULL TEXT  

Effect of Nurse-Directed Diabetes Care in a Minority Population
Davidson
Diabetes Care 2003;26:2281-2287.
ABSTRACT | FULL TEXT  

Racial Differences in Diabetic Nephropathy, Cardiovascular Disease, and Mortality in a National Population of Veterans
Young et al.
Diabetes Care 2003;26:2392-2399.
ABSTRACT | FULL TEXT  

The Need to Improve
Bergstrom
Diabetes Care 2003;26:1633-1634.
FULL TEXT  

Excess Risk of Chronic Kidney Disease among African-American versus White Subjects in the United States: A Population-Based Study of Potential Explanatory Factors
Tarver-Carr et al.
J. Am. Soc. Nephrol. 2002;13:2363-2370.
ABSTRACT | FULL TEXT  

End-stage renal failure in African Americans: insights in kidney disease susceptibility
Freedman
Nephrol Dial Transplant 2002;17:198-200.
FULL TEXT  

Ethnicity and Risk of Diabetes-Related Lower Extremity Amputation: A Population-Based, Case-Control Study of African Caribbeans and Europeans in the United Kingdom
Leggetter et al.
Arch Intern Med 2002;162:73-78.
ABSTRACT | FULL TEXT  

Prevalence and Risk Factors of Microalbuminuria in a Cohort of African-American Women With Gestational Diabetes
Go et al.
Diabetes Care 2001;24:1764-1769.
ABSTRACT | FULL TEXT  

Effect of a Pharmacist-Managed Diabetes Care Program in a Free Medical Clinic
Davidson et al.
American Journal of Medical Quality 2000;15:137-142.
ABSTRACT  

Low Birth Weights Contribute to the High Rates of Early-Onset Chronic Renal Failure in the Southeastern United States
Lackland et al.
Arch Intern Med 2000;160:1472-1476.
ABSTRACT | FULL TEXT  

Epidemiology of De Novo Acute Renal Failure in Hospitalized African Americans: Comparing Community-Acquired vs Hospital-Acquired Disease
Obialo et al.
Arch Intern Med 2000;160:1309-1313.
ABSTRACT | FULL TEXT  

Diabetic Retinopathy in African Americans With Type 1 Diabetes: The New Jersey 725: II. Risk Factors
Roy
Arch Ophthalmol 2000;118:105-119.
ABSTRACT | FULL TEXT  

Hypertensive nephrosclerosis: pathogenesis and prevalence : Essential hypertension is an important cause of end-stage renal disease
Luke
Nephrol Dial Transplant 1999;14:2271-2278.
FULL TEXT  

A Community-Based Study of Explanatory Factors for the Excess Risk for Early Renal Function Decline in Blacks vs Whites With Diabetes: The Atherosclerosis Risk in Communities Study
Krop et al.
Arch Intern Med 1999;159:1777-1783.
ABSTRACT | FULL TEXT  

Impact of Nativity and Race on "Stroke Belt" Mortality
Lackland et al.
Hypertension 1999;34:57-62.
ABSTRACT | FULL TEXT  

Effect of Calcium Channel or ß-Blockade on the Progression of Diabetic Nephropathy in African Americans
Bakris et al.
Hypertension 1997;29:744-750.
ABSTRACT | FULL TEXT  

The Effect of Angiotensin-Converting-Enzyme Inhibition on Diabetic Nephropathy
Fournier et al.
NEJM 1994;330:937-938.
FULL TEXT  

BLACKS HAVE HIGHER RISK OF END-STAGE RENAL DISEASE
JWatch General 1992;1992:1-1.
FULL TEXT