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Native Americans and Chronic Kidney Disease

Although Native Americans make up just 1.5 percent of the U.S. population, they have the highest rate of diabetes in the world and one of the highest rates of end stage renal disease (ESRD). ESRD is the last stage (stage five) of chronic kidney disease. It is a stage when dialysis or a kidney transplant becomes necessary to live. So why are many Native Americans getting kidney disease and what can be done?

Diabetes is the leading cause of CKD

Because Native Americans are more likely to develop diabetes, they are also more likely to develop chronic kidney disease. Diabetes is the leading cause of renal disease; between 10-21 percent of people with diabetes develop chronic kidney disease. But for Native Americans, the rate of kidney disease is climbing even higher. The rate of end stage renal disease among Native Americans with diabetes is six times higher than among non-Native Americans.

About 12.2 percent of Native Americans over the age of 19 have type 2 diabetes. Type 2 diabetes occurs when the body cannot produce enough insulin. Insulin is a hormone that helps transport glucose (or sugar) to the cells in your body. Glucose is energy; your body turns the food you eat into this simple sugar, which is used as fuel. When your body doesn’t produce enough insulin, glucose remains in your bloodstream. If not diagnosed and treated, high blood sugar levels can damage small blood vessels in the eyes, feet and kidneys over time.

When the tiny blood vessels in the kidneys are damaged, your kidneys won’t be able to get rid of all the excess fluid and waste in your bloodstream. As more blood vessels become damaged, even less waste and fluid are filtered from the body. This excess waste and fluid will remain in your bloodstream and may make you feel ill and bloated. Over time, if left untreated, the damage becomes so severe that the kidneys are unable to get rid of the majority of waste and fluid and dialysis or a transplant becomes necessary to live.

Looking for a genetic link

Although the cause of diabetes is unknown, genes, diet, obesity and lack of exercise may play a role in developing diabetes, especially type 2 diabetes. But why do Native Americans have such high rates of diabetes and kidney disease? Scientists began to study the Pima Indians of Arizona, a group of Native Americans who develop kidney failure at a rate 20 times greater than the general population. Kidney disease is the leading cause of death for the tribe. More than 90 percent of the cases of end stage renal disease in the Pima tribe result from diabetes, which they develop at a relatively young age. While Caucasians on average are diagnosed with diabetes at age 60, Pimas are typically only 36-years old.

Researchers now believe that the Pima Indians may share one or more genes that make them more likely to contract the kidney disease of diabetes (KDDM), which often leads to kidney failure. They also found a link between high blood pressure and kidney disease among the Pimas. Thanks to clinical studies with the Pimas and other individuals, ACE inhibitor drugs (first used to treat high blood pressure) are now being used to slow the progression of kidney disease in people who have diabetes.

Know your risk and take charge

People in the early stages of kidney disease experience very few symptoms. They often do not know they have kidney disease. Unfortunately, most cases of chronic kidney disease are diagnosed when significant damage has already occurred. If you are aware of your risk for kidney disease, you are able to take steps to make sure you get an early diagnosis. An early diagnosis and treatment plan will help keep as much of your kidney function as possible and delay the need for dialysis.

If you have a family history of diabetes, or if you feel you are at risk for diabetes because you are overweight or because of your ethnicity, schedule regular check-ups with your family doctor. With an early diagnosis of diabetes, your doctor can monitor your kidneys and recommend treatment at the first sign of decreased function. If you have already been diagnosed with diabetes, follow your doctor’s advice to stay healthy. Managing your diabetes by taking your prescribed medicines and following your doctor’s recommendations regarding exercise and diet is important in preventing or slowing the damage to your kidneys.

Becoming educated about kidney disease and diabetes is a great way to take charge of your health. Discuss any concerns or questions about your condition with your doctor. You can also learn more about kidney disease and diabetes here at DaVita.com.

If you would like to see a doctor who specializes in the care of kidneys, called a nephrologist, you can use DaVita's Find a kidney doctor tool to locate a nephrologist in your area.

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