End-stage renal disease due to diabetes in racial/ethnic minorities and disadvantaged populations.

This review presents data on end-stage renal disease (ESRD) due to diabetes (ESRD-DM) from populations of several racial/ethnic groups and regions; it also identifies factors that may explain differences in risk of ESRD-DM among these groups. Diabetes is a major cause of ESRD in several developed countries, including the United States, England, and Australia. However, in these countries, the incidence is much higher for some groups, such as Blacks and Native Americans in the United States, Blacks and Indo-Asians in England, and indigenous populations in Australia. Despite the worldwide increase in the prevalence of diabetes, in some regions such as South Africa and Brazil, the rates of ESRD attributed to hypertension and glomerulonephritis are even higher than rates attributed to diabetes. High prevalence of accelerated/ malignant hypertension and infection-related glomerulonephritis in addition to a higher risk of early death from diabetes might partially explain the predominance of ESRD attributed to hypertensive nephropathy and glomerulonephitis in South Africa and Brazil. These data call attention to the need to develop more effective strategies to prevent type 2 diabetes and thereby reduce the racial/ethnic gap in ESRD-DM. A greater emphasis on hypertension and diabetes control, particularly in racially and economically disadvantaged populations, is also necessary.