Racial Differences In Prevalence Of Renal Disease

Some familial clustering of diabetic nephropathy may be accounted for by racial background, as diabetic nephropathy occurs at different rates in different racial groups. Several inter-racial comparisons have been made [6-10]. Rostand et al. [6] and Cowie et al. [9] both reported higher rates of end-stage renal disease in African American than Whites, and Pugh et al. [7] reported higher rates in

Mogensen CE (ed.) THE KIDNEY AND HYPERTENSION IN DIABETES MELLITUS. Copyright© 2004 by Martin Dunitz, a member of the Taylor & Francis Group, plc. All rights reserved.

Mexican Americans than in Non-Hispanic Whites. Diabetes duration, which is a strong risk factor for end-stage renal disease, may account for some of the racial differences in these studies. However, with diabetes duration accounted for, Haffner et al. [8] found higher rates of proteinuria among Mexican Americans, and there are several reports of very high rates of renal disease among the Pima Indians [11-14], a population that has high rates of type 2 diabetes [15,16]. The incidence of end-stage renal disease in Pima Indians was similar to that in subjects with type1 diabetes in Boston, Massachusetts [11], but almost four times as high as in Caucasians with type 2 diabetes in Rochester, Minnesota [14].

The reasons for inter-population differences in rates of renal disease are unclear. Rostand [10] has argued that barriers to medical care for African Americans and Mexican Americans may impede early detection, and therefore, control of microalbuminuria and hypertension with a consequent adverse effect on the prevalence of renal disease. However, the cost, one of the major barriers to medical care, is not a factor for the Pima Indians, who have access to free medical care by providers who are well aware of the high risk of diabetic renal disease in this population. Thus, cost of medical care cannot be the only reason for racial differences. However, other aspects of access to medical care, such as transportation or cultural barriers, could be important.

Genes predisposing to renal disease might well exist at different frequencies in different races resulting in differences in susceptibility. Thus, if renal disease is genetic, its prevalence might be expected to differ by race. However, finding different rates in different races is consistent not only with genetic inheritance but also with differing environmental exposures or with differences in competing causes of death.

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