American Indians and Alaska Natives are nearly three times as likely as non-Hispanic Whites to get diabetes. And when they do, their diabetes is more likely to cause end-stage kidney disease than in the rest of the U.S. population. Researchers looked at how these patients fared over a decade. Brandon Varilek, a professor of nursing at the University of Nebraska, spoke to Harvard Public Health.
Why study this topic?
The purpose of this study was a survival analysis of people with end-stage kidney disease, when their kidneys are failing and they need dialysis.
What did you find?
I spent about two-and-a-half weeks on the Pine Ridge Reservation, working in the emergency room and also as a transplant coordinator. I see how challenging it is for them to get high-quality health care to keep their diabetes managed. Some of these people live five or six hours away from the transplant facility.
Compared to non-Hispanic white diabetes patients, American Indians and Alaska Natives survived longer on dialysis, with an 18.4 percent decrease in risk of death. But they are also diagnosed with end-stage disease much sooner. They progress rapidly through the stages of chronic kidney disease, coming to the emergency room because their kidneys are no longer working.
What would you like to see happen based on the results of the study?
Once they have diabetes, there’s not a lot of good follow-up. I’d like to get chronic kidney disease patients into doctor visits before they even get to the end-stage, whether it’s in a local clinic or a nephrology hospital unit. I would also love to see more discussions about advanced care and end-of-life planning.
—Leah Samuel
(Study in Springer Nature, September 2024)