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American Journal of Kidney Diseases

End-Stage Renal Disease in US Minority Groups

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      Medicare's End-Stage Renal Disease (ESRD) Program makes renal replacement services accessible for, the majority of Americans with renal failure. National data from Medicare demonstrate complex and variable patterns of use of renal replacement services among US racial and ethnic groups. The black population has consistently suffered from a greater than 3.5-fold higher rate of treated ESRD than has the white population. The rates of hypertensioe, diabetic, and glomerulopathic ESRD are all substantially greater in blacks than in whites, and hypertension has accounted for a far greater proportion of ESRD in blacks than any other diagnosis. There is a paucity of national data on the occurrence of ESRD in Hispanic Americans. However, data from Texas strongly suggest that the incidence rate of treated ESRD is much higher in Mexican Americans than in non-Hispanic whites. Higher rates are apparent for each of the three most important causes of ESRD: hypertension, diabetes, and glomerulonephritis. Native Americans experience ESRD at a rate intermediate between those of whites and blacks, but their rate of diabetic ESRD is higher than in either blacks or whites. However, considerable diversity exists among Native American tribal groups. Significant barriers to the acquisition of preventive care have been identified, especially for blacks. While these barriers to preventive care are accompanied by a significantly impaired health status of the black American population, a specific causal relationship between impaired access to care for blacks and their predisposition to ESRD has not been established.

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      References

      1. Study of Unentitled End-Stage Renal Disease Patients.
        in: Report to Congress, Department of Health and Human Services, Health Care Financing Administration, Office of Research and Demonstrations. June 1984
        • Pearson DA
        • Stranova TJ
        • Thompson JD
        Characteristics of Connecticut patients receiving services for end-stage uremia.
        Public Health Rep. 1975; 90: 440
        • Easterling RE
        Racial factors and the incidence and causation of end-stage renal disease.
        Trans Am Soc Artif Intern Organs. 1977; 23: 38-42
        • Mausner JS
        • Clark JK
        • Coles BI
        • et al.
        An area-wide survey of treated end-stage renal disease.
        Am J Public Health. 1978; 68: 166
        • Rostand SG
        • Kirk K
        • Rutsky E
        • et al.
        Racial differences in the incidence of treatment for end-stage renal disease.
        N Engl J Med. 1982; 306: 1276-1279
        • Sugimoto T
        • Rosansky SJ
        The incidence of treated endstage renal disease in the eastern United States 1973-1979.
        Am J Public Health. 1984; 74: 14-17
        • Ferguson R
        • Grim CE
        • Opgenorth TJ
        The epidemiology of end-stage renal disease: The six-year south-central Los Angeles experience, 1980-85.
        Am J Public Health. 1987; 77: 864-865
        • Hosten AO
        Kidney diseases in blacks in North America.
        Transplant Proc. 1987; 19: 5-8
        • Weller JM
        • Wu SCH
        • Ferguson CW
        • et al.
        End-stage renal disease in Michigan: Incidence, underlying causes, prevalence, and modalities of treatment.
        Am J Nephrol. 1985; 5: 84
        • Pugh JA
        • Stern MP
        • Haffner SM
        • et al.
        Excess incidence of treatment of end-stage renal disease in Mexican Americans.
        Am J Epidemiol. 1988; 127: 135-144
      2. 1990 Annual Data Report.
        in: US Renal Data System, Bethesda, MD, NIH, NIDDK, NKDUB. 1990
        • Whittle J
        • Whelton PK
        • Klag MJ
        • et al.
        Does racial variation in risk factors explain black-white differences in hypertensive end-stage renal disease?.
        Arch Intern Med. 1991; 151: 1359-1364
        • Newman JM
        • Marfin AA
        • Eggers PW
        • et al.
        End-stage renal disease among Native Indians 1983-1986.
        Am J Public Health. 1990; 80: 318-319
        • Pasinski R
        • Pasinski M
        End-stage renal disease among the Zuni Indians: 1973-1983.
        Arch Intern Med. 1987; 147: 1093-1096
        • Hoy WE
        • Megill DM
        • Hughson MD
        Epidemic renal disease of unknown etiology in the Zuni Indians.
        Am J Kidney Dis. 1987; 9: 485-496
        • Bahr AA
        Current status of dialysis as a method of treatment in kidney failure in the Gila River Indian Community.
        in: US Public Health Service Report. 1981
        • Justice J
        Preliminary report on renal dialysis and renal insufficiency on the Papago Reservation, 1961-1981.
        in: US Public Health Service Report. 1981
        • Teutsch S
        Risk factors for diabetic nephropathy among the Utes on the Uintah and Ouray Reservations.
        in: US Public Health Service Report. 1981
      3. Chart Series, Indian Health Service.
        in: US Public Health Service. 1987
        • Megill DM
        • Hoy WE
        • Wodruff SD
        Rates and causes of end-stage renal disease in Navajo Indians, 1971-1985.
        West J Med. 1988; 149: 178-182
      4. Stahn RM: The incidence and prevalence of end-stage renal disease in Northern Plains Indians. (unpublished manuscript, June 1989)

        • Rate RG
        • Knowler WC
        • Morse HG
        • et al.
        Diabetes mellitus in Hopi and Navajo Indians.
        Diabetes. 1983; 32: 894-899
        • Knowler WC
        • Pettitt DJ
        • Bennett PH
        • et al.
        Diabetes mellitus in the Pima Indians: Genetic and evolutionary considerations.
        Am J Anthropol. 1983; 62: 107-114
        • Nelson RG
        • Newman JM
        • Knowler WC
        • et al.
        Incidence of end-stage renal disease in type 2 (non-insulin-dependent) diabetes mellitus in Pima Indians.
        Diabetologia. 1988; 31: 730-736
        • Kunzelman C
        • Knowler W
        • Pettitt D
        • et al.
        Incidence of proteinuria in type 2 diabetes mellitus in Pima Indians.
        Kidney Int. 1989; 35: 681-687
        • Bennett PH
        • Burch TA
        • Miller M
        Diabetes mellitus in American Pima Indians.
        Lancet. 1971; 2: 125-128
        • Neel JV
        Diabetes mellitus: A "thrifty" genotype rendered detrimental by "progress"?.
        Am J Hum Genet. 1962; 14: 353-362
        • Stern MP
        • Rosenthal M
        • Haffner SM
        • et al.
        Sex differences in the effects of sociocultural status on diabetes and cardiovascular risk factors in Mexican Americans: The San Antonio Heart Study.
        Am J Epidemiol. 1984; 120: 834-851
        • Franco LJ
        • Stern MP
        • Rosenthal M
        • et al.
        Prevalence, detection, and control of hypertension in a biethnic community: The San Antonio Heart Study.
        Am J Epidemiol. 1985; 121: 684-696
        • Gardner LI
        • Stern MP
        • Haffner SM
        • et al.
        Prevalence of diabetes in Mexican Americans: Relationship to percent of gene pool derived from native American sources.
        Diabetes. 1984; 3: 86-92
        • Stern MP
        Diabetes in Hispanic Americans.
        in: Harris M Hamman RF Diabetes in America. US Department of Health and Human Services, Bethesda, MD1985 (IX 111 (NIH publication no. 85-1468))
        • Chiapella AP
        • Feldman HI
        End-stage renal disease in Hispanic males.
        Am J Epidemiol. 1991; 134 (abstr): 271-272
        • Eggers PW
        Mortality rates among dialysis patients in Medicare's End-Stage Renal Disease Program.
        Am J Kidney Dis. 1990; 15: 414-421
        • Brunner HR
        • Seale JE
        • Laragh JH
        Renin subgroups in essential hypertension. Further analysis of their pathophysiological and epidemiological characteristics.
        Circ Res. 1973; 1 (suppl): 99-105
        • Levy SB
        • Lilley JJ
        • Frigon RP
        • et al.
        Urinary kallikrein and plasma renin activity as determinants of renal blood flow.
        The influence of race and dietary sodium intake. J Clin Invest. 1977; 60: 129-138
        • Lilley J
        • Hsu L
        • Stone R
        Racial disparity of plasma volume in hypertensive man.
        Ann Intern Med. 1976; 84: 707-708
        • Weinberger MH
        • Miller JZ
        • Luft FC
        • et al.
        Definitions and characteristics of sodium sensitivity and blood pressure resistance.
        Hypertension. 1986; 3: 11127-11134
        • Langford HG
        Dietary potassium and hypertension: Epidemiologic data.
        Ann Intern Med. 1983; 98: 770-772
        • McDonough JR
        • Garrison GE
        • Hames CG
        Blood pressure and hypertensive disease among Negroes and whites.
        Ann Intern Med. 1964; 61: 208-212
        • Luft FC
        • Grim CE
        • Weinberger MH
        Electrolyte and volume homeostasis in blacks.
        in: Hall WD Saunders E Shulman NB Hypertension in Blacks: Epidemiology, Pathophysiology, and Treatment. Year Book Medical, Chicago, IL1985: 115-131
        • Dunn FG
        • Oigman W
        • Sungaard-Riise K
        • et al.
        Racial differences in cardiac adaptation to essential hypertension determined by echocardiographic indexes.
        J Am Coll Cardiol. 1983; 5: 1348-1351
        • Rowlands DB
        • DeGiovanni J
        • McLeay R
        • et al.
        Cardiovascular response in black and white hypertensives.
        Hypertension. 1982; 4: 817-820
        • Levy SB
        • Talner LB
        • Coel MN
        • et al.
        Renal vasculature in essential hypertension: Racial differences.
        Ann Intern Med. 1978; 88: 12-16
        • Pitcock JA
        • Johnson JG
        • Hatch FE
        • et al.
        Malignant hypertension in blacks.
        Malignant intrarenal arterial disease as observed by light and electron microscopy. Hum Pathol. 1976; 7: 333-346
        • Dustan HP
        • Curtis JJ
        • Luke RG
        • et al.
        Systemic hypertension and the kidney in black patients.
        Am J Cardiol. 1987; 60: 731-771
        • Rowland M
        • Roberts J
        Blood pressure levels and hypertension in persons ages 6-74 years: United States, 1976-1980. National Center for Health Statistics, Washington, DC1982: 1-11 (Advance Data, no. 84)
        • McClellan W
        • Elbert T
        • Issa A
        Racial differences in the incidence of hypertensive end-stage renal disease (ESRD) are not entirely explained by differences in the prevalence of hypertension.
        Am J Kidney Dis. 1988; 12: 285-290
        • Brancati F
        • Whittle J
        • Whelton P
        • et al.
        Do racial differences in diabetes prevalence explain the excess of diabetic ESRD in blacks?.
        J Am Soc Nephool. 1991; 2 (abstr): 286
        • Tierney WM
        • Clement MJ
        • Luft FC
        Renal disease in hypertensive adults. Effect of race and type II diabetes mellitus.
        Am J Kidney Dis. 1989; 13: 485-493
        • Rostand SG
        • Brown G
        • Kirk KA
        • et al.
        Renal insufficiency in treated essential hypertension.
        N Engl J Med. 1989; 320: 684-688
        • Roseman JM
        Diabetes in black Americans.
        in: Harris MI Hamman RF Diabetes in America. US Department of Health and Human Services, Bethesda, MD1985 (VIII 1-24 (NIH publication no. 85-1468))
        • Friedman EA
        • Rao TKS
        • Sprung CL
        Uremia in sickle cell anemia treated by maintenance hemodialysis.
        N Engl J Med. 1974; 291: 431-435
        • Friedman EA
        Why does uremia in heroin abusers occur predominantly among blacks?.
        JAMA. 1983; 250: 2965-2966
        • Cunningham EE
        • Zielezny MA
        • Venuto RC
        Heroinassociated nephropathy: A nationwide problem.
        JAMA. 1983; 250: 2935-2936
      5. US Bureau of the Census. Persons of Spanish origin in the United States, March 1980, in Current Population Reports. US GPO, Washington, DC1981 (Series P-20, no. 361)
        • Whelton PK
        • Klag MJ
        Hypertension as a risk factor for renal disease.
        Hypertension. 1989; 13 (suppl 1): 119-127
        • Shulman NB
        • Ford CE
        • Hall WD
        • et al.
        Prognostic value of serum creatinine and effect of treatment of hypertension on renal function: Results from the Hypertension Detection and Follow-up Program.
        Hypertension. 1989; 13 (suppl 1 ): 180-193
        • Klahr S
        The modification of diet in renal disease study.
        N Engl J Med. 1989; 320: 864-865
        • Shulman NB
        • Martinez B
        • Brogan D
        • et al.
        Financial cost as an obstacle to hypertension therapy.
        Am J Public Health. 1986; 76: 1105-1108
        • Franco LJ
        • Stern MP
        • Rosenthal M
        • et al.
        Prevalence, detection and control of hypertension in a biethnic community: The San Antonio Heart Study.
        Am J Epidemiol. 1985; 121: 684-696
        • Kjellstrand CM
        • Logan GM
        Racial, sexual, and age inequities in chronic dialysis.
        Nephron. 1987; 45: 257-263
        • Rettig RA
        Study of the Medicare End-Stage Renal Disease Program.
        Am J Kidney Dis. 1990; 15: 491-493