Type 2 diabetes is the leading cause of chronic kidney disease (CKD). Although Native Americans represent just a small fraction (1.5%) of the U.S. population, they have the highest rate of diabetes of any racial group in the world. As a result, they also suffer disproportionately from kidney disease and kidney failure. 

Approximately 12.2% of Native Americans age 19 or older have type 2 diabetes, and the rate of end-stage kidney disease (ESKD) among Native Americans living with diabetes is six times higher than the rate among non-Native Americans. DaVita Kidney Care explores why so many Native Americans get chronic kidney disease and what can be done.*

Why are Native Americans prone to diabetes and kidney disease?

Poor diet, obesity, and a sedentary lifestyle are known risk factors for diabetes that we’ve been aware of for some time. Their effects, however, usually accrue over the course of a lifetime, and it doesn’t explain why so many young people in a specific population are developing these diseases. 

A study involving the Pima Indians of Arizona revealed that they:

• develop diabetes at a younger age (on average at age 36 vs. age 60 for Caucasians);
• progress to kidney failure at a rate that is 20 times higher than the general population; and
• have a high rate of hypertension (high blood pressure), which is the second leading cause of CKD.

More than 90% of the cases of ESKD in the Pima tribe are the result of early-onset diabetes. 

Experts now believe that the Pima Indians have a genetic predisposition to developing diabetes-related kidney disease, which is the most likely type to progress to kidney failure. While this study can’t be generalized to include all Native Americans, it provides an important base from which to study the devastating impact the disease has on this population. 

What can be done?

Controlling diabetes and hypertension are the most effective ways to prevent, or at least delay, kidney failure. Increased and appropriately-targeted disease education and regular kidney testing are the keys to better health outcomes, but any health initiative must be adapted for the population it addresses in order to be successful.

The use of ACE inhibitor drugs, population health, and team-based approaches by the Indian Health Service (IHS) have already made a significant dent in the dismaying statistics. Between 1996 and 2013, kidney failure from diabetes among Native Americans dropped by 54%. IHS’s model can serve as an example for other communities, to be reproduced and further adapted as necessary.

To do this, the Centers for Disease Control and Prevention (CDC) recommend that healthcare systems take the following actions:

• Use population-based data and approaches to promote diabetes care.
• Assess long-term outcomes.
• Address disparities in health and access to care.
• Promote healthy communities by connecting people to local resources and supporting quality food supply, transportation, housing, and mental health care.
• Develop team-based care that includes patient education, community outreach, care coordination, outcome tracking and disease surveillance, and access to providers including dieticians, pharmacists, etc.
• Improve diabetes care by integrating kidney disease education and prevention, screening people with diabetes for kidney disease, and managing hypertension.

Further reading can be found in the CDC’s PDF on “Native Americans with diabetes: Better diabetes care can decrease kidney failure.”

*DaVita Kidney Care. (n.d.). Native Americans and Chronic Kidney Disease.