Racial Differences in Kidney Function Among Individuals With Obesity and Metabolic Syndrome: Results From the Kidney Early Evaluation Program (KEEP)

Bomback, Andrew S.; Kshirsagar, Abhijit V.; Whaley‐Connell, Adam; Chen, Shu‐Cheng; Li, Suying; Klemmer, Philip J.; McCullough, Peter A.; Bakris, George L.

doi:10.1053/j.ajkd.2009.10.045

Cited by 16 publications

(6 citation statements)

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“…Indeed, stratified analyses (Table 4) suggest that GDM may be a different, and more harmful, disease for African American women and women with obesity compared with white women and nonobese women, respectively. As demonstrated in recent reports from KEEP (18,19), these patient groups may derive extra benefit from screening for albuminuria in the setting of preserved GFR. Our data also suggest that this screening is crucial when hypertension, with or without concomitant diabetes, has developed in the years after delivery.…”

Section: Discussionmentioning

confidence: 94%

Gestational Diabetes Mellitus Alone in the Absence of Subsequent Diabetes Is Associated With Microalbuminuria

et al. 2010

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OBJECTIVEWomen with gestational diabetes mellitus (GDM) maintain a higher risk for recurrent GDM and overt diabetes. Overt diabetes is a risk factor for development of chronic kidney disease (CKD), but GDM alone, without subsequent development of overt diabetes, may also pose a risk for CKD.RESEARCH DESIGN AND METHODSThis cross-sectional analysis included Kidney Early Evaluation Program (KEEP) participants from 2000 to 2009. Patient characteristics and kidney function among three categories (GDM alone, overt diabetes, and no history of diabetes) were compared. The prevalence of microalbuminuria, macroalbuminuria, and CKD stages 1–2 and 3–5 was assessed using logistic regression.RESULTSOf 37,716 KEEP female participants, 571 (1.5%) had GDM alone and 12,100 (32.1%) had overt diabetes. Women with GDM had a higher rate of microalbuminuria but not macroalbuminuria than their nondiabetic peers (10.0 vs. 7.7%) that was substantially lower than the 13.6% prevalence in diabetic women. In multivariate analysis, women with GDM alone, compared with nondiabetic women, demonstrated increased odds of CKD stages 1–2 (multivariate odds ratio 1.54 [95% CI 1.16–2.05]) similar to the odds for women with overt diabetes (1.68 [1.55–1.82]). In stratified analyses, age, race, BMI, and hypertension modified the odds for CKD stages 1 –2 but not CKD stages 3–5 among women with GDM.CONCLUSIONSWomen with GDM alone have a higher prevalence of microalbuminuria than women without any history of diabetes, translating to higher rates of CKD stages 1–2. These results suggest that GDM, even in the absence of subsequent overt diabetes, may increase the risk for future cardiovascular and kidney disease.

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Section: Discussionmentioning

confidence: 94%

Gestational Diabetes Mellitus Alone in the Absence of Subsequent Diabetes Is Associated With Microalbuminuria

et al. 2010

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“…In the Kidney Early Evaluation Program study, NHWs were more likely to have metabolic syndrome with hypertension, DM, and a greater decrease in estimated glomerular filtration rate than blacks. 73 In the same cohort, male sex was associated with hypertension, DM, lower estimated glomerular filtration rate, and albuminuria, which were predictive of end-stage renal disease, whereas age, male sex, DM, lower estimated glomerular filtration rate, and albuminuria were predictive of mortality. 74 As noted above, men are thought to be at greater risk for renal injury, especially hypertensive individuals with DM, resulting perhaps from the presence of androgens.…”

Section: Sex Differences: Dm and Hypertensionmentioning

confidence: 91%

Sex Differences in the Cardiovascular Consequences of Diabetes Mellitus

et al. 2015

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Currently, ≈1 in 13 people living in the United States has DM, and 90% to 95% of these individuals have type 2 DM (T2DM).2 Overall, the prevalence of T2DM is similar in women and men. In the United States, ≈12.6 million women (10.8%) and 13 million men (11.8%) ≥20 years of age are currently estimated to have T2DM. 2 Among individuals with T2DM, cardiovascular disease (CVD) is the leading cause of morbidity and mortality and accounts for >75% of hospitalizations and >50% of all deaths.3 Although nondiabetic women have fewer cardiovascular events than nondiabetic men of the same age, this advantage appears to be lost in the context of T2DM. 4,5 The reasons for this advantage are not entirely clear but are likely multifactorial with contributions from inherent physiological differences, including the impact of the sex hormones, differences in cardiovascular risk factors, and differences between the sexes in the diagnosis and treatment of DM and CVD. 6 In addition, there are racial and ethnic factors to consider because women of ethnic minority backgrounds have a higher prevalence of DM than non-Hispanic white (NHW) women.This scientific statement was designed to provide the current state of knowledge about sex differences in the cardiovascular consequences of DM, and it will identify areas that would benefit from further research because much is still unknown about sex differences in DM and CVD. Areas that are discussed include hormonal differences between the sexes and their possible effects on the interaction between DM and CVD, sex differences in epidemiology, ethnic and racial differences and risk factors for CVD in DM across the life span, sex differences in various types of CVD and heart failure, and sex differences in the effects of treatments for DM, including both medications and lifestyle. In addition, there is discussion about risk factors that are specific to women, including gestational diabetes mellitus (GDM) and polycystic ovarian syndrome (PCOS), which affect CVD risk. Table 1 focuses on sex differences in CVD risk factors and outcomes in DM, and Table 2 provides information about sex differences in CVD treatments and interventions in DM. Table 3 contains some of the important ideas for research in sex differences in the cardiovascular consequences of DM. The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on July 31, 2015, and the American Heart Association Executive Committee on September 5, 2015. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By...

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“…These disparities in incidence and prevalence have been shown to be a function of high levels of kidney disease risk factors in African Americans, including diabetes, hypertension, and obesity. 3–10 The purpose of this study was to determine kidney disease knowledge in African American patients diagnosed with kidney disease.…”

Section: Introductionmentioning

confidence: 99%

African American patient knowledge of kidney disease: A qualitative study of those with advanced chronic kidney disease

et al. 2014

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Kidney disease is a costly and prevalent condition that affects African Americans more than any other group. The purpose of this study was to determine the knowledge of kidney disease African American patients have about their disease. Four qualitative focus groups were conducted with kidney disease patients in which the patients gave thoughts and opinions on kidney disease and various components and factors of the condition. The data were independently reviewed and analyzed using Qualrus coding software. Dominant themes discussed in the focus groups included: causes of kidney disease, patient thoughts on dialysis as a treatment for kidney disease, information source for disease knowledge, thoughts on God and faith, reaction to kidney disease, and types of treatment available. The study found that the majority of patients were unaware of specific causes and risk factors of kidney disease, were unsure of available treatments, and had a severe lack of knowledge and support system in dealing with the condition. Early prevention and education programs aimed at high-risk populations would be very beneficial in decreasing the incidence and increase of kidney disease.

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Racial Differences in Kidney Function Among Individuals With Obesity and Metabolic Syndrome: Results From the Kidney Early Evaluation Program (KEEP)

Cited by 16 publications

References 55 publications

Gestational Diabetes Mellitus Alone in the Absence of Subsequent Diabetes Is Associated With Microalbuminuria

Gestational Diabetes Mellitus Alone in the Absence of Subsequent Diabetes Is Associated With Microalbuminuria

Sex Differences in the Cardiovascular Consequences of Diabetes Mellitus

African American patient knowledge of kidney disease: A qualitative study of those with advanced chronic kidney disease

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