New onset chronic kidney disease in people with diabetes highest among ethnic, racial minorities

Patient receiving dialysis
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New onset chronic kidney disease (CKD) in people with diabetes is highest among racial and ethnic minority groups compared with white persons, a UCLA-Providence study finds.

The study, published as a letter to the editor in the New England Journal of Medicine, found that new onset CKD rates were higher by approximately 60%, 40%, 33%, and 25% in the Native Hawaiian/Pacific Islander, Black, American Indian/Alaska Native, and Hispanic/Latino populations, respectively, compared to white persons with diabetes.

Although high CKD incidence in diabetes persists, the rate declined from 8% of the overall diabetes population in 2015-2016 to 6.4% in 2019-2020”.

“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,” said co-author Dr. Susanne Nicholas, 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. “The first step should be to increase the rates of screening and detection of CKD in individuals with diabetes.”

Researchers from the Geffen School, Providence, and the Centers for Disease Control and Prevention tracked 654,549 adults with diabetes from 2015 through 2020 using electronic health records from Providence Health and UCLA Health, two large not-for-profit health systems serving the Western United States.

The prevalence of kidney failure requiring dialysis or transplant more than doubled to nearly 800,000 persons in the United States between 2000 and 2019, with diabetes as the leading cause. The rate of new onset of CKD in people with diabetes was previously unknown, yet the value of such incidence data is vital for identifying high-risk populations, determining the effectiveness of interventions, and assessing the effects on health care delivery and public health responses. Even more striking, less than 10% of patients with early stage kidney disease are aware of having CKD at this stage in its progression, when therapies are most effective. 

“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,” said lead author Dr.  Katherine Tuttle, executive director for research at Providence Inland Northwest Health and professor of medicine at the University of Washington. “Inclusive strategies for prevention, detection, and intervention are needed to reduce CKD risk in people with diabetes.”

Additional study authors are Dr. O. Kenrik Duru and Dr. Keith Norris of UCLA; Cami Jones, Kenn Daratha, Dr. Radica Alicic, and Joshua Neumiller of Providence; and Nilka Ríos Burrows, Alain Koyama, and Dr. Meda Pavkov of the Centers for Disease Control and Prevention.