DETERMINANTS OF END-STAGE RENAL-DISEASE IN PIMA-INDIANS WITH TYPE-2 (NON-INSULIN-DEPENDENT) DIABETES-MELLITUS AND PROTEINURIA

To identify factors related to the development of end-stage renal dise ase after the onset of proteinuria, its incidence was determined in 36 4 Pima Indians aged 35 years or older with Type 2 (non-insulin-depende nt) diabetes mellitus and proteinuria (protein-to-creatinine ratio gre ater-than-or-equal-to 0.5 g/g). Of these 364 subjects, 95 (36 men, 59 women) developed end-stage renal disease. The cumulative incidence was 40% 10 years after and 61 % 15 years after the onset of proteinuria. The incidence of end-stage renal disease was significantly related to the duration of diabetes, the duration of proteinuria, higher 2-h plas ma glucose concentration, type of diabetes treatment, and the presence of retinopathy at the time of recognition of the proteinuria, but not to age, sex, or blood pressure. Duration of proteinuria influenced th e risk of end-stage renal disease, contingent, however, upon the durat ion of diabetes at the onset of proteinuria. The higher cumulative inc idence of end-stage renal disease 15 years after the onset of proteinu ria in Pima Indians (61 %) than in Caucasians from Rochester, Minnesot a (17 %) may be attributable, in part, to the younger age of onset of Type 2 diabetes in Pima Indians than in Caucasians, to ethnic differen ces in susceptibility to renal disease, or to lower death rates among the Pima Indians from competing causes of death, such as coronary hear t disease.