Advanced diabetic nephropathy disproportionately affects African-American females: cross-sectional analysis and determinants of renal survival in an academic renal clinic.

OBJECTIVE The aims of this study were to study further the previously observed 2-fold higher prevalence of endstage renal disease (ESRD) due to diabetic nephropathy (DN) in African-American (AA) women, when compared to AA men, and to identify factors predictive of renal survival in this population. DESIGN Cross-sectional analysis of DN in an academic renal clinic. METHODS We identified and retrospectively studied all patients with diabetic nephropathy enrolled in our renal clinic in 1996. Charts were reviewed for basic demographic factors, medications, and renal function. RESULTS Of approximately 600 total patients, 141 were diagnosed with DN, and sufficient data was available on 119 (98 AA) of these, with a mean followup of 105 weeks. Patients were hypertensive, had advanced renal disease at presentation (creatinine [Cr]=3.97 mg/dL), and had been diabetic for 16.7 years. The AAs were disproportionately represented by females (69 vs 29). Seventy patients reached ESRD at the time of analysis (April 2000) with a mean time to dialysis of 79.3 weeks. Significant determinants for longer time to ESRD (TTE) were: lower presenting Cr, female gender, and AA race. A MAP<100 mm Hg over the course of followup was adversely related to TTE. Among AAs, taking an angiotensin converting enzyme (ACE) inhibitor, or a calcium channel blocker, was associated with better renal survival. Changes in renal function at 1 and 2 years were associated with age, urine protein at presentation, and MAP over the course of followup. CONCLUSIONS In Mississippi, DN is more much more prevalent in AA females, compared to AA males. In those with advanced DN, MAP<100 mm Hg may lessen the chances for renal survival.