Endstage renal disease owing to diabetic nephropathy in Mississippi: An examination of factors influencing renal survival in a population prone to late referral

Background: Diabetic nephropathy (DN) is the leading cause of endstage rena l disease (ESRD) in the United States, We reviewed our experience with DN a s a cause of ESRD in a predominantly poor, African American (AA) population . Methods: Charts of patients who entered the ESRD program through the Univer sity of Mississippi Medical Center with a primary diagnosis of DN from 1993 through 1998 were reviewed for factors that mat; affect renal survival. Ti me from initial clinic visit to entry into the ESRD program,, or time to ES RD CITE), was the primary; end point. Results: Five hundred sixty-two patients entered the ESRD program (85% AA), and 210 of them had DIU as their primary ESRD diagnosis. DN accounted for 50.5% of ESRD cases among AA females, but for less than 20% among AA males. In contrast, hypertension was the ESRD diagnosis in 48% of AA males, Patie nts observed in our nephrology clinic were analyzed further (n=171). At pre sentation, patients had advanced disease (serum creatinine [Cr]=5.92 mg/dL) , were hypertensive, obese, and not likely to be on an angiotensin-converti ng enzyme (ACE) inhibitor. Determinants of TTE: in univariate analysis were race (AA. did better), initial blood urea nitrogen and plasma serum Cr lev els, starting an ACE inhibitor at the University of Mississippi Medical Cen ter, and the level of mean arterial pressure (MAP) during the course of fol low-up, On multivariate analysis only initial Cr and race remained signific ant. The 142 AA diabetics (111 female) were analyzed separately. The only s ignificant sex difference was body mass index (female, 33.6 vs male, 28.4 k g/m(2); P=0.0069), but females tended to have relatively shorter TTE and hi gher blood pressure (BP), Univariate and multivariate analyses revealed the same factors as above as determinants of TTE; however, among AAs, presenti ng on a calcium channel blocker was negatively correlated with TTE in univa riate analysis. Among the entire cohort and the AAs, patients who had MAP b etween 100 and 110 mm Hg during die course of follow-up did better in terms of renal survival than those who fell outside of that range, Conclusion: We conclude that AA females in Mississippi are significantly mo re predisposed to DN as a cause of ESRD than are AA males. Patients with DN in our population had poor BP control, presented to nephrologists with adv anced disease, and often were not on an ACE inhibitor. The optimal level of BP control and which BP agents are best for this population need to be det ermined.