Increased albuminuria risk among Asian Americans with diabetes differs by ethnicity
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Key takeaways:
- Asian adults with diabetes have a higher risk for albuminuria than white adults.
- The risk for albuminuria is highest among Filipino adults.
- Future studies should analyze Asian ethnicity subgroups.
Asian adults with diabetes and normal kidney function have a higher risk for albuminuria than non-Hispanic white adults, but the risk varies among ethnic subgroups, according to a brief report published in Diabetes Care.
“Albumin in the urine is the first indicator that a patient has diabetic kidney disease,” Joan C. Lo, MD, research scientist at the Kaiser Permanente Division of Research in Oakland, California, told Healio. “It is important to have this information because early diabetic kidney disease is a condition that can be managed with medication and lifestyle modification. Knowing there are higher risk groups creates potential for more awareness among physicians about screening and interventions.”
Lo and colleagues conducted a retrospective analysis of data from 79,184 adults aged 45 to 74 years with diabetes, normal kidney function with a preserved estimated glomerular filtration rate of 60 mL/min/1.73 m2 or higher, and an albuminuria assessment available (mean age, 60.5 years; 54% men). Data were collected from the Kaiser Permanente Northern California Diabetes Registry. Race and ethnicity were self-reported. Microalbuminuria was defined as a urine albumin-to-creatinine ratio of 30 mg/g to 299 mg/g, and macroalbuminuria was defined as a urine albumin-to-creatinine ratio of 300 mg/g or higher.
Of the study cohort, 40.3% were non-Hispanic white, 26.3% were Asian or Pacific Islander, 21% were Hispanic and 9.6% were Black. Normal albumin-to-creatinine ratios were observed in 81.7% of the cohort; 13.8% had microalbuminuria and 4.6% had macroalbuminuria. The prevalence of albuminuria was higher for Asian adults (21.1%), Black adults (18.6%) and Hispanic adults (17.6%) than white adults (16.8%). After adjusting for covariates, Asian and Pacific Islander adults had a higher risk for albuminuria than white adults (adjusted RR = 1.45; 95% CI, 1.39-1.5), but no increased risk was observed for Black or Hispanic adults.
Albuminuria prevalence and risk differed by ethnic subgroups. Native Hawaiian and Pacific Islander adults (27.9%) and Filipino adults (25.3%) had a higher prevalence of albuminuria than Chinese adults (18.1%), whereas South Asian adults had a lower albuminuria prevalence (14.6%). Japanese and Southeast Asian adults had a similar albuminuria prevalence to Chinese adults.
After adjusting for covariates, Filipino adults had a higher risk for albuminuria than Chinese adults (adjusted RR = 1.16; 95% CI, 1.07-1.24), whereas South Asian adults (aRR = 0.72; 95% CI, 0.64-0.82) and Japanese adults (RR = 0.83; 95% CI, 0.72-0.96) had lower risks than Chinese adults. Lo said it was intriguing to see the differences in albuminuria risk among the subgroups.
“For decades, we have typically used the overarching category ‘Asian’ in research,” Lo said. “But the Asian community is a very diverse population with people from various geographic locations with different heritages, different dietary habits and different socioeconomic status that can impact their health and their risks for specific diseases.”
Lo said the findings should push researchers to conduct more studies that examine Asian populations by specific ethnic subgroups.
For more information:
Joan C. Lo, MD, can be reached at joan.c.lo@kp.org.
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