Risk factors that can lead to chronic kidney disease and ESRD occur commonly throughout the adult US. population. These include diabetes mellitus, hypertension, obesity, elevated cholesterol levels, a family history of chronic kidney disease, smoking, substance abuse, age, male gender, and being of nonwhite race.

Diabetes Mellitus

In the United States, diabetes mellitus (both type-1 and type-2) is the most commonly attributed cause of ESRD, accounting for over one-third of incident cases. eriacta 100 mg

The prevalence of type-2 diabetes is two-to-five times higher in Hispanics than in non-Hispanic whites. In addition, peak age-specific incidence of diabetes among Hispanics occurs in patients aged 50-59 years, a decade earlier than in non-Hispanic whites, suggesting that risk factors may operate at earlier ages in this minority population.

Diabetes is particularly common among Mexican Americans and Puerto-Rican Americans, whereas Cuban Americans have only a slightly higher risk than non-Hispanic whites. Furthermore, Mexican Americans are likely to suffer more severe complications of diabetes than the general U.S. population. The San Antonio Heart Study showed that Mexican Americans with diabetes are six times more likely to develop ESRD requiring dialysis than non-Hispanic white diabetics.

It is unclear why Mexican Hispanics are so susceptible to diabetes, but the reason is likely to be related to risk factors that commonly cluster with diabetes, including obesity, hypertension, and a genetic predisposition. Socioeconomic factors have also been implicated, but the published literature has so far failed to confirm this possibility. Mexican Americans of low socioeconomic status have a higher prevalence of type-2 diabetes than Mexican Americans with a higher socioeconomic status. Analysis of data from the San Antonio Heart Study showed that, contrary to expectations, low socioeconomic status was not asso­ciated with greater levels of hyperglycemia.

Whatever the reasons for the propensity of the Hispanic population to develop diabetes, the problem is likely to grow. The number of Hispanics with diabetes is increasing, as is the mortality rate associated with diabetes in Hispanics.

Hypertension

Hypertension represents a major threat to the Hispanic population, despite the finding that Hispanics do not have higher rates of hypertension than the general U.S. population.

A study in Texas that focused on individuals aged over 75 years showed that the incidence of hypertensive ESRD was two-and-a-half times higher in Mexican Americans than in non-Hispanic whites, which is a surprising finding given the rate of hypertension in the Hispanic population. This suggests that when hypertension does occur in this population, it is less likely to be controlled than in the general U.S. population. The undertreatment of hypertension in Mexican Americans may reflect the attitude of Hispanics who tend to consider hypertension to be a normal part of aging that is untreatable, whereas non-Hispanic whites have a less fatalistic view of hypertension as a preventable condition. As a result, Hispanics are less likely than non-Hispanic whites to have their blood pressure checked.

Their lack of concern about blood pressure has been demonstrated by research showing that only approximately half of hypertensive Hispanics know that they have high blood pressure, and only approximately one-quarter of these individuals have their blood pressure under control. Such patients are no doubt vulnerable to the effects of hypertension and, by the time hypertension is treated, the kidneys may already be irreversibly damaged.

Obesity

Obesity is generally more common among Hispanics than the general white population of the United States. Obesity is closely linked with type-2 diabetes and, as is the case for diabetes, the prevalence of obesity is higher among Mexican Americans than among Cuban Americans or Puerto-Rican Americans. Mexican Americans of low socioeconomic status are particularly prone to obesity, especially central obesity, which is itself a risk factor for diabetes.
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Other Factors

The Hispanic population may have a genetic predisposition to kidney disease. Mexican Americans, who are most at risk for kidney disease, share a common genetic background with Native-American Indians, themselves a high-risk group for diabetes and ESRD. A retrospective analysis of children living in the Chicago area by Moore et al. showed that, although the progression of kidney disease to ESRD was more common in Hispanics and African Americans, there was no significant difference in the principal etiologies leading to ESRD. In Hispanic children, 44% and 47% of cases of ESRD were urologic or due to primary glomerular disease, respectively, and only 9% were heredofamilial.

Another factor to consider is that a “thrifty genotype” may predispose Hispanics to obesity and diabetes. Many Hispanic Americans are descendants of Native-American hunter-gatherers, who evolved to store fat more easily in times of plentiful food to increase survival in times of famine. In modern westernized societies, individuals with unrestricted access to food who do not exercise regularly will gain weight. The thrifty gene compounds this problem as it stimulates increased insulin production. This overproduction results in impairment of insulin action and the onset of type-2 diabetes mellitus.

In other racial groups, such as Aboriginals, early infections in children—particularly impetigo due to streptococcal infection—may contribute to glomerular hematuria, proteinuria, and persistent glomerulonephritis in children. This represents a possible risk for chronic glomerulonephritis and subsequent ESRD in adult life.

The importance of other risk factors, such as cigarette smoking, for ESRD in the Hispanic population requires further investigation, but risk may be linked to socioeconomic status. Almost three times as many Hispanic as non-Hispanic families are below the poverty level, and financial problems are compounded by the generally larger families in this predominantly Catholic community.
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While pancreas plus kidney transplants provide the best therapeutic option for kidney failure in type-1 diabetes, it is important to note that, in the United States, more than 95% of new diabetics with kidney disease have type-2 diabetes. More concerted efforts to educate patients on control of diabetes through medical care, diet, and exercise may be an important strategy to adopt with all newly diagnosed diabetics.

Category: Diseases / Tags: culture, healthcare policies, Hispanics, risk factors

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