Predicting Kidney Function Decline in American Indian and Alaska Native Populations with Diabetes

Résumé fourni par la source

Background: Chronic kidney disease (CKD) and diabetes disproportionately affect the American Indian and Alaskan Native (AI/AN) population, but knowledge of CKD risk factors and predictors of kidney function decline is limited in this population. Methods: Health records from the Providence health system were used to identify AI/AN and White non-Hispanic (WNH) adults with diabetes in 2013-2022. Kaplan-Meier analysis was used to longitudinally assess major adverse kidney events (MAKE) defined as ≥40% estimated glomerular filtration rate (eGFR) decline, eGFR <15 mL/min/1.73 m2, dialysis or kidney transplant, and all-cause death in the AI/AN population and reference group (WNH). A Cox multivariable model was used to estimate associations of demographic, clinical and residential predictors with MAKE. Results: The AI/AN population with diabetes (N=6,103) was younger (mean±standard deviation age 54±15 years) with higher HbA1c (mean 7.4±2.2%) compared to the WNH population (N=354,283; age 62±14 years; HbA1c 6.9±1.8%). MAKE were more frequent among AI/AN population (26%, n=1,584) compared with the reference group (24%, n=85,920). In adjusted analyses, MAKE risk was higher in the AI/AN population (p <0.0001) (Figure A). AI/AN race in the adjusted Cox model was associated with higher MAKE hazard (hazard ratio [HR] 1.20, 95% CI 1.15-1.27). In the AI/AN population, Social Vulnerability Index (HR 1.03, 95% CI 1.00-1.05) and hospitalizations (HR 1.7, 95% CI 1.54-1.89) were associated with higher, while primary care visits had lower, hazards of MAKE (HR 0.80, 95% CI 0.72-0.90) (Figure B). Conclusion: In this real-world cohort study, we observed higher MAKE risk in the AI/AN population with adjustment for clinical and residential measures. Pragmatic studies to assess system level interventions for recognition and treatment of CKD in the AI/AN population with diabetes are needed. Funding: NIDDK Support

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.