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The Occurrence of Diabetic Kidney Disease among Different Racial Demographics

Diabetic kidney disease is a prevalent, yet hardly understood disease. Although such
diseases used to lack substantial treatments, advancements in science have allowed many to
control this chronic disease in their daily lives. But, as the United States has seen more and more
cases of diabetes, other health effects, especially kidney disease, have also proliferated in the
same way. Diabetes and kidney disease both have a strong correlation through their resulting
symptoms and overall disproportionate, yet individually related, effects on different racial
demographics.
Why has the increasing rate of diabetic kidney disease had such different effects on
different races? There are many answers to this underlying question. In looking at diabetes and
kidney disease individually, beyond the overall increase in cases of diabetes, kidney disease has
been on the rise also. As many are aware, diabetes is a widely seen cause of kidney disease and
eventually kidney failure. In order to understand this, we must first look at what these two
diseases are and how they affect each other to fully understand the cause of the effects on
different racial demographics.
Diabetes affects millions of people across the United States. However, the different types
of diabetes are often not as understood. Type 1 and Type 2 diabetes both cause a high blood
sugar level, but for different reasons. Type 1 diabetes is simply caused by the pancreas not
producing enough insulin. However, Type 2 diabetes, which is more prevalent, can have the
same cause, but insulin resistance due to muscle cells, fat cells, and liver cells responding
differently to the insulin produced by the body can specifically result in Type 2 diabetes.
1


1
Medical News Today. MediLexicon International, n.d. Web. 10 Feb. 2014.
<http://www.medicalnewstoday.com/info/diabetes/>.
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On the other hand, what is kidney disease? The kidneys, located a little bit above the
pancreas, have the important function of removing waste from the blood in the body. Kidneys
are vital human organs which provide several processes to maintain proper bodily functions. The
kidneys major function is to filter out the bodys metabolic waste from the blood stream. In
addition, kidneys also release important hormones to help regulate the levels of salts in our body,
red blood cell production, bone health, to name a few, in the words of Dr. Nancy Xu, a trained
nephrologist who has worked with numerous cases of diabetic kidney disease.
2
In general, if the
kidneys are damaged, they can no longer perform the essential function of removing fluid and
waste from the body.
However, multiple treatments can be used for kidney disease. According to Dr. Xu,
When kidney function is more severely reduced, patient[s] require help removing waste from
the blood stream (such as through dialysis or kidney transplant) and/or supplement hormones.
3

Now that we understand what both diabetes and kidney disease are independently, how
does diabetes cause kidney disease, you may think? Well, as the kidneys filter the blood, the
excessive blood sugar level seen in diabetes causes the capillaries to begin to filter and remove
the waste from too much blood in the body. As a result, these filters that clean the blood leak as
protein starts exiting the body through waste. Many times, one with diabetes can tell if the onset

Board, A.D.A.M. Editorial. Type 2 Diabetes. U.S. National Library of Medicine, 18 June 2013. Web. 13 Feb. 2014.
<http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001356/>.

2
Xu, Nancy. "Science Writing Interview Questions." Message to the author. 13 Feb. 2014. E-mail.
3
Xu, Nancy. "Science Writing Interview Questions." Message to the author. 13 Feb. 2014. E-mail.
Crentsil 3

of kidney disease has begun based on the presence of protein in the urine.
4
This condition is
referred to as diabetic kidney disease.
5

However, if the high blood sugar level caused by diabetes continues, the kidneys start
losing function from the high amounts of stress that result from working overtime to filter too
much blood. Eventually, waste starts to build up in the body, causing kidney failure as the
kidneys fully stop filtering the blood.
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Fortunately, this is not inevitable. With a well-controlled blood sugar level, a person with
diabetes can prevent the kidneys from this excessive blood filtering in the body, helping their
regulation of diabetes and the prevention of kidney disease. However, it is still a cause for
concern as Dr. Xu explains, The most common cause of chronic kidney disease is diabetes,
which causes about 35% of all chronic kidney disease.
7

If we take a deeper look at the effects of diabetes and kidney disease, the relationship
between symptoms outweighs the differences. The related symptoms of these two diseases
further show their correlation. The symptoms seen in both diseases include upset
stomach/nausea, weakness, poor appetite, and frequent urination. The fact that these diseases
share these similar effects on the body also shows the degree to which the progression of
diabetes can lead to the development of kidney disease.
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4
"Kidney Disease (Nephropathy): American Diabetes Association." American Diabetes Association. N.p., n.d.
Web. 13 Feb. 2014. <http://www.diabetes.org/living-with-diabetes/complications/kidney-disease-
nephropathy.html>.

5
"Featured Story." The National Kidney Foundation: A to Z Health Guide. N.p., n.d. Web. 12 Feb. 2014.
<http://www.kidney.org/atoz/content/diabetes.cfm>.

6
"Kidney Disease (Nephropathy): American Diabetes Association." American Diabetes Association. N.p., n.d.
Web. 13 Feb. 2014. <http://www.diabetes.org/living-with-diabetes/complications/kidney-disease-
nephropathy.html>.
7
Xu, Nancy. "Science Writing Interview Questions." Message to the author. 13 Feb. 2014. E-mail.
8
"Polycystic Kidney Disease." Symptoms. N.p., n.d. Web. 13 Feb. 2014. <http://www.mayoclinic.org/diseases-
conditions/polycystic-kidney-disease/basics/symptoms/CON-20028831>.
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Diabetes and kidney disease affect the body similarly, but both diseases have different
effects on different racial demographics. Dr. Xu has seen this in her work with diabetic kidney
disease, and when asked if she has seen any disproportionality among the rates of diabetic kidney
disease, she explains, Yes, the incidence of diabetic nephropathy are increased in blacks (3- to
6-fold compared to Caucasians), Mexican-Americans, and Pima Indians with type 2 diabetes.
It is unfortunate, yet widely known that the African American population has a higher

prevalence of kidney disease. Although African Americans make up about 13% of the United

States population, 32% of those suffering from kidney failure are African American.
9
Based on

this information, an understandable correlation between diabetes and kidney disease is seen

among African Americans. African Americans also have a higher rate of diabetes, as 4.9 million

people, about 18.7 percent of the African American population, are affected by diabetes, and the

National Kidney Disease Education Program cites diabetes as the number one cause of kidney

failure among African Americans.
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The rate of the prevalence of diabetes in terms of percentage among Caucasians is not
extremely lower than that of African Americans. 10.2 %, about 15.7 million Caucasians have
diabetes.
11
Although this rate is 8.5% less than the diabetes rate among African Americans, due


"Diabetes Symptoms: Excessive Thirst, Nausea, Vision Problems, and More." WebMD. WebMD, n.d. Web. 13 Feb.
2014. <http://www.webmd.com/diabetes/understanding-diabetes-symptoms>.
9
"Race, Ethnicity and Kidney Disease." - National Kidney Disease Education Program (NKDEP). N.p., n.d. Web. 13
Feb. 2014. <http://nkdep.nih.gov/learn/are-you-at-risk/race-ethnicity.shtml>.
10
"What African Americans with Diabetes or High Blood Pressure Need to Know." - National Kidney Disease
Education Program (NKDEP). N.p., n.d. Web. 13 Feb. 2014. <http://nkdep.nih.gov/resources/african-american-
kidney-disease.shtml>.
"The Facts About Diabetes: A Leading Cause of Death in the U.S." Diabetes and Prediabetes Statistics and Facts.
N.p., n.d. Web. 11 Feb. 2014. <http://ndep.nih.gov/diabetes-facts/>.
11
"The Facts About Diabetes: A Leading Cause of Death in the U.S." Diabetes and Prediabetes Statistics and Facts.
N.p., n.d. Web. 11 Feb. 2014. <http://ndep.nih.gov/diabetes-facts/>.

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to the discrepancy between the sheer numbers of the populations, 3 times as many Caucasian
individuals as African American individuals have diabetes.
Interestingly, Caucasians have an overall lower prevalence of kidney disease than African
Americans despite the higher case by case prevalence of diabetes. This shows that although the
correlation between these diseases is clear, there are slight differences and exceptions, as
different demographics cannot fully be characterized under certain standards.
The understood relationship is also seen among the Hispanic demographic. About 1 in 10
Hispanics, somewhere near 9.2%, have diabetes.
12
Although the prevalence of diabetes among
Hispanics is only 1% greater than that of Caucasians, Hispanics are more likely to develop
kidney disease compared to Caucasians.
13
This further shows the connection between the two
diseases, although it affects different races disproportionately. But, many organizations have
even sought to specifically assist Hispanics due to the high prevalence of kidney disease as an
effect of the rate of diabetes.
Why does this disproportionality occur? As Dr. Xu explains, Several factors may be at
play. Medical literature cites socioeconomic factors, such as diet, obesity, the level of control of
hyperglycemia, hypertension as contributing causes. There are also likely genetic factors. For
example, Pima Indians, have larger glomeruli than Caucasians, may have enhanced susceptibility
to kidney disease from diabetes. In addition, there appears to be as much as a 4.8-fold increase
in the risk of end-stage kidney disease due to diabetes in blacks than non-blacks, after
considering for the other factors.
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12
"Hispanic Americans - Are You at Risk for Kidney Disease?" Hispanic Americans - Are You at Risk for Kidney
Disease? N.p., n.d. Web. 13 Feb. 2014. <http://www.kidneyfund.org/kidney-health/are-you-at-risk/hispanic-
americans.html>.
13
"Race, Ethnicity and Kidney Disease." - National Kidney Disease Education Program (NKDEP). N.p., n.d. Web. 13
Feb. 2014. <http://nkdep.nih.gov/learn/are-you-at-risk/race-ethnicity.shtml>.
14
Xu, Nancy. "Science Writing Interview Questions." Message to the author. 13 Feb. 2014. E-mail.
Crentsil 6

Beyond the analysis of this important information, what can we do to end this? Lets
look at the source, the prevention and ending of diabetes. As Type 2 diabetes is significantly
more prevalent, from my perspective, the best place to start would be to put an end to the spike
in diabetes cases seen in the United States. Although diabetes does not cause all of the cases
seen in kidney disease, preventing the proliferation of diabetes can definitely cut down the
effects.
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But this does not need to be done alone- the National Kidney Foundation and
American Diabetes Association lead advocacy to end both diseases. The only way to know if you
have diabetes or kidney disease is through medical testing. Ultimately, medical testing and
widespread awareness and collaboration can work to save countless lives.















15
"Featured Story." The National Kidney Foundation: A to Z Health Guide. N.p., n.d. Web. 12 Feb. 2014.
<http://www.kidney.org/atoz/content/diabetes.cfm>.
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Works Cited:
"Age-Adjusted Percentage of Civilian, Noninstitutionalized Population with Diagnosed Diabetes, by Race and Sex, United
States, 19802011." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 28 Mar.
2013. Web. 13 Feb. 2014. <http://www.cdc.gov/diabetes/statistics/prev/national/figraceethsex.htm>.
Board, A.D.A.M. Editorial. Type 2 Diabetes. U.S. National Library of Medicine, 18 June 2013. Web. 13 Feb. 2014.
<http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001356/>.
"Clinical Diabetes." The Disparate Impact of Diabetes on Racial/Ethnic Minority Populations. N.p., n.d. Web. 13 Feb. 2014.
<http://clinical.diabetesjournals.org/content/30/3/130.full>.
"Diabetes." Diabetes. N.p., n.d. Web. 13 Feb. 2014. <http://www.healthcentral.com/encyclopedia/408/150.html?ic=506048>.
"Diabetes Symptoms: Excessive Thirst, Nausea, Vision Problems, and More." WebMD. WebMD, n.d. Web. 13 Feb. 2014.
<http://www.webmd.com/diabetes/understanding-diabetes-symptoms>.
"Diabetes Symptoms: Excessive Thirst, Nausea, Vision Problems, and More." WebMD. WebMD, n.d. Web. 13 Feb. 2014.
<http://www.webmd.com/diabetes/understanding-diabetes-symptoms>.
"Diagnosing Diabetes and Learning About Prediabetes: American Diabetes Association." American Diabetes Association.
N.p., n.d. Web. 12 Feb. 2014. <http://www.diabetes.org/diabetes-basics/diagnosis/>.
"The Facts About Diabetes: A Leading Cause of Death in the U.S." Diabetes and Prediabetes Statistics and Facts. N.p., n.d.
Web. 11 Feb. 2014. <http://ndep.nih.gov/diabetes-facts/>.
"Featured Story." The National Kidney Foundation: A to Z Health Guide. N.p., n.d. Web. 12 Feb. 2014.
<http://www.kidney.org/atoz/content/diabetes.cfm>.
"Hispanic Americans - Are You at Risk for Kidney Disease?" Hispanic Americans - Are You at Risk for Kidney Disease? N.p.,
n.d. Web. 13 Feb. 2014. <http://www.kidneyfund.org/kidney-health/are-you-at-risk/hispanic-americans.html>.
"Kidney Disease Causes and Basic Information." WebMD. WebMD, n.d. Web. 11 Feb. 2014. <http://www.webmd.com/a-to-z-
guides/understanding-kidney-disease-basic-information>.
"Kidney Disease (Nephropathy): American Diabetes Association." American Diabetes Association. N.p., n.d. Web. 13 Feb.
2014. <http://www.diabetes.org/living-with-diabetes/complications/kidney-disease-nephropathy.html>.
Medical News Today. MediLexicon International, n.d. Web. 10 Feb. 2014. <http://www.medicalnewstoday.com/info/diabetes/>.
"National Kidney and Urologic DiseasesInformation Clearinghouse (NKUDIC)." Kidney Diseases Statistics for the United
States. N.p., n.d. Web. 13 Feb. 2014. <http://kidney.niddk.nih.gov/kudiseases/pubs/kustats/#4>.
"Polycystic Kidney Disease." Symptoms. N.p., n.d. Web. 13 Feb. 2014. <http://www.mayoclinic.org/diseases-
conditions/polycystic-kidney-disease/basics/symptoms/CON-20028831>.
"Race, Ethnicity and Kidney Disease." - National Kidney Disease Education Program (NKDEP). N.p., n.d. Web. 13 Feb. 2014.
<http://nkdep.nih.gov/learn/are-you-at-risk/race-ethnicity.shtml>.
"What African Americans with Diabetes or High Blood Pressure Need to Know." - National Kidney Disease Education Program
(NKDEP). N.p., n.d. Web. 13 Feb. 2014. <http://nkdep.nih.gov/resources/african-american-kidney-disease.shtml>.
Xu, Nancy. "Science Writing Interview Questions." Message to the author. 13 Feb. 2014. E-mail.