Kidney failure in Native Americans and Alaska Natives with diabetes has declined drastically over the last 20 years, according to new data released as part of this month’s Vital Signs report by the CDC.
“The 54 percent decline in kidney failure from diabetes followed implementation of public health and population approaches to diabetes as well as improvements in clinical care by the IHS [Indian Health Service],” said Mary L. Smith, principal deputy director of the Indian Health Service.
Of all U.S.-based populations, Native Americans are the most susceptible to diabetes and are about twice as likely as white Americans to develop diabetes. Furthermore, 69% of kidney failure deaths in Native Americans are the result of diabetes (MMWR. 2017 Jan 10. doi: 10.15585/mmwr.mm6601e1).
Since 1996, however, kidney failure has dropped more among Native Americans than any other ethnic group in the country. The 54% drop represents a decrease from 57.3 diabetes-related end-stage renal disease cases per 100,000 population in 1996 to 26.5 per 100,000 population in 2013 among U.S. adults.
“This decline is especially remarkable given the well-documented health and socioeconomic disparities in the [Native American and Alaska Natives] population, including poverty, limited health care resources, and disproportionate burden of many health problems,” wrote the authors of the Vital Signs report.
According to the report, blood sugar control among Native American populations has improved by 10%, kidney testing in diabetic Native Americans aged 65 years or older is 50% greater than Medicare diabetes patients of the same age, and the average blood pressure of Native Americans with both diabetes and hypertension was 133/76 in 2015.
“We believe these strategies can be effective in any population,” Ms. Smith stated, a sentiment that was also shared by Tom Frieden, MD, director of the CDC.
“Strong coordinated clinical care and education, community outreach and environmental changes can make a dramatic difference in reducing complications from diabetes for all Americans,” Dr. Frieden said in a statement.
Not only does diabetes persist as a significant burden on the U.S. health care system, but kidney failure in particular can be costly. Figures released by the CDC indicate that average medical costs associated with kidney failure in 2013 were as high as $82,000 per patient, with Medicare spending nearly $14 billion for kidney failure treatments in the same year.
“The findings in this report are consistent with other studies among [Native Americans and Alaska Natives] nationwide and among Pima Indians in the Southwest, which concluded that improvements in blood pressure, blood glucose, and the use of ACE inhibitors and [angiotensin II receptor blockers] played a significant role in the decline of [diabetes-related end-stage renal disease] in these populations,” the report concludes.
To ensure that kidney failure decreases continue in Native Americans, the U.S. government will continue funding diabetes screening and prevention efforts in applicable communities, assist community health care facilities to provide care for diabetes, and will establish a nationwide system for tracking chronic kidney disease. The CDC also advocates using population approaches and coordinated care to treat diabetes, advising health care professionals to “integrate kidney disease prevention and education into routine diabetes care.”
“The Indian Health Service has made tremendous progress by applying population health and team-based approaches to diabetes and kidney care,” Dr. Frieden stated.