End-Stage Renal Disease due to Diabetes Among Southwestern American Indians, 1990–2001

Abstract

OBJECTIVE—This study assesses trends in the incidence of diabetes-related end-stage renal disease (ESRD) among southwestern American Indians (SWAIs). RESEARCH DESIGN AND METHODS—Using the U.S. Renal Data System, we obtained the total number of new cases of treated ESRD in which diabetes was the primary cause of renal failure in 1990 through 2001. The incidence of diabetes-related ESRD was calculated using census population figures and estimates of the SWAI population with diabetes, then age-adjusted to the 2000 U.S. population. RESULTS—Between 1990 and 2001, the annual number of new patients starting treatment for diabetes-related ESRD in the SWAI total population increased from 154 to 320, and the age-adjusted diabetes-related ESRD incidence per 10,000 population increased 34% (6.2–8.3 per 10,000 people). However, after adjusting for the increasing number of people with diabetes in the SWAI population between 1993 and 2001, the age-adjusted incidence of diabetes-related ESRD among SWAIs with diabetes decreased 31%, from 80.4 to 55.8 per 10,000 people with diabetes. It decreased for both sexes and in all age-groups. CONCLUSIONS—The increasing incidence of diabetes-related ESRD in the SWAI population parallels the growing prevalence of diabetes. However, since 1993 diabetes-related ESRD incidence decreased in the SWAI population with diabetes, consistent with national trends. This may reflect the reduction in risk factors and improvements in diabetes care practices in Indian communities.