END-STAGE RENAL-DISEASE IN SPECIFIC ETHNIC AND RACIAL GROUPS - RISK-FACTORS AND BENEFITS OF ANTIHYPERTENSIVE THERAPY

During the past few years, it has become apparent that there are facto rs that place a person at greater risk for the development and progres sion of renal failure. This has been documented since the early 1980s by the United States Renal Data System that has collected data confirm ing that end-stage renal disease occurs at a greater rate in certain s ubpopulations of Americans. It is evident from an examination of the d ata that African Americans and American Indians have an incidence of e nd-stage renal disease that is not Proportional to their percentage of the total population, In fact, African Americans and American Indians are reported to have at least a 4-fold greater incidence of end-stage renal disease than white Americans. There have been 5 factors identif ied: hypertension, glucose intolerance, insulin resistance, salt sensi tivity, and hyperlipidemia, which may play a greater role in these sub populations. In addition, as with other populations, lifestyle issues may serve to alter these primary risk factors or may act as direct mod ulators of renal disease progression. There is also a possibility that interactions between risk factors frequently occur that may modify th e development or progression of the disease. This article reviews thes e risk factors and emphasizes the interaction between hypertension and the other factors. In addition, the effects of antihypertensive agent s on risk factors and on renal outcome are emphasized. Where possible, issues specific to African Americans and American Indians are undersc ored; however, one must accept that the database on these populations is only now developing. This review should help the clinician make app ropriate choices when prescribing antihypertensive therapy for patient s who may be at risk of developing progressive renal failure.