New-onset CKD in diabetes highest among racial, ethnic minorities in US
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New-onset chronic kidney disease among U.S. adults with diabetes was highest among racial and ethnic minorities compared with white individuals, according to findings published in The New England Journal of Medicine.
“The results of our study constitute a call to action to institute directed, targeted efforts aimed at deliberately shifting the trajectory of persistently high rates of diabetes-related CKD and kidney failure that disproportionately affect racial and ethnic minority groups,” Susanne B. Nicholas, MD, PhD, associate professor of medicine in the division of nephrology at the David Geffen School of Medicine at UCLA and chair of the UCLA Nephrology Racial and Health Equity Committee, said in a related press release. “The first step should be to increase the rates of screening and detection of CKD in individuals with diabetes.”
Researchers followed 654,459 adults with diabetes aged 20 years or older from 2015 to 2020 (mean age, 61 years; 55.2% women) through electronic health records from the Center for Kidney Disease Research, Education and Hope registry from two U.S. health care systems, Providence Health and UCLA Health. Researchers identified incident CKD by at least two positive laboratory tests performed at least 90 days apart or by administrative code.
CKD incidence was higher among Native Hawaiian or other Pacific Islander adults compared with white adults (RR = 1.56; 95% CI, 1.38-1.77). CKD incidence was also higher among Black adults (RR = 1.41; 95% CI, 1.33-1.5), American Indian or Alaska Native adults (RR = 1.33; 95% CI, 1.19-1.5) and Hispanic/Latino adults (RR = 1.25; 95% CI, 1.2-1.3). However, researchers observed a lower rate ratio for CKD among Asian adults compared with white adults (RR = 0.87; 95% CI, 0.82-0.92).
During 2015 and 2016, overall CKD incidence declined from 81.6 cases per 1,000 person-years to 64 cases per 1,000 person-years during 2019 and 2020. Researchers observed similar trends across demographic subgroups of age, race, ethnic group and sex.
Compared with the general U.S. population, the Center for Kidney Disease Research, Education and Hope registry had a higher percentage of Asian or Pacific Islander individuals and white individuals with diabetes and a lower percentage of Black individuals and Hispanic/Latino individuals with diabetes.
According to the researchers, the persistently high CKD incidence in the U.S. is troubling despite the recent decline, and less than 10% of adults with early-stage kidney disease are aware of their CKD.
“Given the rapidly growing population with diabetes in the United States and the corresponding high rates of kidney failure, the persistently high incidence of CKD marked by racial and ethnic disparities is troubling,” Katherine R. Tuttle, MD, executive director for research at Providence Inland Northwest Health and professor of medicine at the University of Washington, Seattle, said in the release. “Inclusive strategies for prevention, detection and intervention are needed to reduce CKD risk in people with diabetes.”
Reference:
- New-onset chronic kidney disease in people with diabetes highest among ethnic, racial minorities. Published Oct. 31, 2022. Accessed Oct. 31, 2022.
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