Prevalence, determinants and co-morbidities of chronic kidney disease among First Nations adults with diabetes: results from the CIRCLE study

BMC Nephrology

Research Article

Mariam Naqshbandi Hayward¹  Stewart B Harris¹  Roland F Dyck² 

[1] Centre for Studies in Family Medicine, Department of Family Medicine, The University of Western Ontario, N6G 4X8, London, Ontario, Canada;Department of Medicine, Royal University Hospital, 103 Hospital Drive, S7N 0W8, Saskatoon, SK, Canada;Department of Community Health and Epidemiology, University of Saskatchewan, S7N 5E5, Saskatoon, SK, Canada;the CIRCLE Study Group, Canada;

关键词: Indigenous peoples;    Aboriginal;    First Nations;    Diabetes;    Chronic kidney disease;    End stage renal disease;    Risk factors.;   

DOI  :  10.1186/1471-2369-13-57

 received in 2012-03-29, accepted in 2012-06-18,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundIndigenous peoples worldwide are experiencing elevated rates of type 2 diabetes and its complications. To better understand the disproportionate burden of diabetic end stage renal disease (ESRD) among Canadian First Nations people (FN), we examined prevalence, determinants, and co-morbidities of chronic kidney disease (CKD) within this population.MethodsThe 2007 Canadian FN Diabetes Clinical Management and Epidemiologic (CIRCLE) study conducted a cross-sectional national medical chart audit of 885 FN adults with type 2 diabetes to assess quality of diabetes care. In this sub-study, participants were divided by estimated glomerular filtration rate (eGFR in ml/min/1.73 m2), as well as by albuminuria level in those with eGFRs = > 60. Those with eGFRs = > 60 and negative albuminuria were considered to have normal/near normal kidney function (non-CKD). Using univariate and logistic regression analysis, they were compared with participants having eGFRs = > 60 plus albuminuria (CKD-alb) and with participants having eGFRs <60 (CKD-eGFR <60).ResultsWhile 84.5% of total CIRCLE participants had eGFRs = > 60, almost 60% of the latter had CKD-alb. Of the 15.5% of total participants with CKD-eGFR <60, 80% had eGFRs 30–60 (Stage 3 CKD) but over 10% (1.6% of total participants) had ESRD. Independent determinants of CKD-alb were male gender and increasing diabetes duration, systolic BP, A1C and total cholesterol. These plus smoking rates also discriminated between FN with micro- and macro-albuminuria. Independent determinants of CKD-eGFR <60 were increasing age at diabetes diagnosis, diabetes duration, total cholesterol and systolic BP. However, participants with CKD-eGFR <60 also displayed a decreasing mean age of diabetes diagnosis as eGFR declined. Micro-vascular co-morbidities were significantly associated with CKD-alb but both micro- and macro-vascular co-morbidities were associated with CKD-eGFR <60. Only 35-40% of participants with CKD used insulin.ConclusionsHigh prevalences of CKD-alb and early CKD-eGFR <60 among diabetic FN were largely related to modifiable and treatable risk factors. However, an earlier age of diabetes diagnosis and longer duration of diabetes characterized those with ESRD. These findings suggest that a failure to meet current standards of diabetes care interacting with an age-related survival benefit contribute to the disproportionate burden of ESRD among FN and possibly other Indigenous peoples.

【 授权许可】

CC BY   
© Dyck et al.; licensee BioMed Central Ltd. 2012