243184 Chronic kidney disease and outcomes in American Indian adults

Tuesday, November 1, 2011

Nawar Shara, PhD , Department of Biostatistics and Epidemiology, MedStar Health Research Institute, Hyattsville, MD
Laura Plantinga, ScM , San Francisco General Hospital, University of California San Francisco, San Francisco, CA
Ying Zhang, MD, PhD, MHS , Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
Stacey Jolly, MD, MS , Department of General Internal Medicine, Cleveland Clinic Medicine Institute, Cleveland, OH
Jason G. Umans, MD, PhD , Georgetown-Howard Universities Center for Clinical and Translational Science, MedStar Health Research Institute and Georgetown University, Hyattsville, MD
Barbara V. Howard, PhD , Senior Scientist, Medstar Research Institute, Hyattsville, MD
Chronic kidney disease (CKD) is common in the U.S. adult population (~25% in those aged ≥60). Previous studies suggest that CKD may be more common in selected American Indian populations. We examined incidence and outcomes of CKD in a prospective cohort study (Strong Heart Study) of adults aged 45-74 from 13 American Indian tribes/communities in Arizona, Oklahoma, and the Dakotas. At first exam (6/89-1/92), there were 4,337 participants with information on albumin:creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR). Reexaminations were conducted in 19931995 and 19981999, and mortality was followed through 12/31/07. CKD was defined as ACR≥30 mg/g (stages 1-2) or eGFR<60 ml/min/m2 (stages 3-5). One-third (34.3%) of participants had CKD at baseline. Among participants free of CKD at the baseline exam, 23.6% had CKD at the third exam, of whom 26.8% had more advanced CKD (stage 3-5). Only 0.3% of those without CKD at baseline progressed to end-stage renal disease (ESRD) by the third exam, but age- and gender-adjusted incidence of ESRD was 2.3%, 10.8%, and 34.3% among those with CKD stages 1, 2, and 3-5, respectively, at baseline. By the end of follow-up, 59.3% vs. 32.0% of participants with vs. without CKD at baseline had died of any cause; cardiovascular mortality was 22.4% vs.8.0%. CKD is highly prevalent in middle-aged and older American Indians, relative to the general population; progression to ESRD and cardiovascular and all-cause mortality may be related to excess diabetic nephropathy in this population.

Learning Areas:
Chronic disease management and prevention

Learning Objectives:
1. Describe the prevalence of chronic kidney disease in middle-aged/older American Indians relative to the general population. 2. Compare the incidence of end-stage renal disease (requiring dialysis or transplant) among those with and without chronic kidney disease at the start of follow-up. 3. Compare rates of all-cause and cardiovascular mortality among those with and without chronic kidney disease.

Keywords: American Indians, Chronic Diseases

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I serve as a statistician on the Strong Heart Study and head the Epidemiology and Statistics Department at MedStart Health Research Institute.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.