Diabetic renal disease: racial and ethnic differences from an epidemiologic perspective.

In summary, Native Americans, Hispanics, and blacks are at higher risk of diabetic ESRD relative to whites, particularly among subjects with NIDDM, even after controlling for the higher prevalence of diabetes in these groups. Incidence of diabetic ESRD is increasing in all race and ethnic groups, particularly in Native Americans and Hispanics. This increase may be real or artifactual. Based on the results of a few studies, controlling for several risk factors for diabetic ESRD does not explain the excess risk in blacks and Hispanics. Survival after beginning treatment for diabetic ESRD is longer in blacks, Native Americans, and Asian/Pacific Islanders when compared to whites. Longer survival in blacks compared with whites occurs among dialysis patients, but not in transplant patients, after controlling for type of diabetes and comorbidity present at onset of ESRD. The higher incidence of diabetic ESRD in blacks, Hispanics, and Native Americans, combined with an increased incidence over time and longer survival after ESRD onset, indicate that these racial and ethnic groups will comprise a large portion of diabetic ESRD in the future.