Ethnic differences in 25-year risk of incident chronic kidney disease among people with type 2 diabetes in New Zealand

Orr-Walker, BJ; Yu, D; Wang, Z; Cai, Y; Osuagwu, UL; Pickering, K; Baker, J; Cutfield, R; Sundborn, G; Jayanatha, K; Zhao, Z; Simmons, D

Abstract

INTRODUCTION: Insights into ethnic differences in the natural history of chronic kidney disease (CKD) among people with type 2 diabetes mellitus (T2DM) might inform clinical strategies to address disparities in hospitalization and mortality. Risks of CKD II-V stages over a 25-year period between New Zealand Europeans (NZEs), Maori and Pasifika, and with T2DM in Auckland, New Zealand (NZ) were compared. RESEARCH DESIGN AND METHODS: As a primary care audit program in Auckland, the Diabetes Care Support Service was linked with national registration databases. People with existing CKD II-V were ruled out. To balance potential confounders, we applied a tapered matching method . 'Quasi-trial'-matched cohorts were set up separately between Maori and NZE and between Pasifika and NZE. Ethnic population differences in risk of any and each stage of CKD over 1994-2018 were examined by weighted Cox regression model. RESULTS: The HRs for developing any CKD, CKD stages II-V for Maori (n=2215) versus NZE (n=2028) were 1.18 (95% CI 0.99 to 1.41), 1.10 (95% CI 0.91 to 1.32), 1.70 (95% CI 1.19 to 2.43), 3.93 (95% CI 2.16 to 7.14), and 3.74 (95% CI 1.74 to 8.05), respectively. Compared with NZE (n=2474), the HRs for developing any CKD, CKD stages II-V for Pasifika (n=3101) were 1.31 (95% CI 1.09 to 1.57), 1.26 (95% CI 1.05 to 1.52), 1.71 (95% CI 1.14 to 2.57), 3.75 (95% CI 1.40 to 10.05), and 4.96 (95% CI 1.56 to 15.75), respectively. CONCLUSIONS: Among people with T2DM in NZ, significant ethnic differences exist in the risk of progressing to each stage of CKD (stage V in particular). Mechanism studies underlying these differences, as well as the need for identification of biomarkers to predict the early onset renal lesion, are warranted.

Citation

Orr-Walker, B., Yu, D., Wang, Z., Cai, Y., Osuagwu, U., Pickering, K., Baker, J., Cutfield, R., Sundborn, G., Jayanatha, K., Zhao, Z., & Simmons, D. (2022). Ethnic differences in 25-year risk of incident chronic kidney disease among people with type 2 diabetes in New Zealand. BMJ Open Diabetes Research and Care, https://doi.org/10.1136/bmjdrc-2022-003077

• Journal Article Type: Article
• Acceptance Date: Oct 14, 2022
• Publication Date: Dec 15, 2022
• Publicly Available Date: May 30, 2023
• Journal: BMJ Open Diabetes Research & Care
• Electronic ISSN: 2052-4897
• Publisher: BMJ Publishing Group
• DOI: https://doi.org/10.1136/bmjdrc-2022-003077
• Keywords: Type 2 Diabetes; Ethnic Groups; Kidney Failure; Chronic; Cohort Studies
• Public URL: https://keele-repository.worktribe.com/output/425222
• Publisher URL: https://drc.bmj.com/content/10/6/e003077
• Additional Information: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/; This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.