Abstract: TH-PO1004
Predicting Kidney Function Decline in American Indian and Alaska Native Populations with Diabetes
Session Information
- Diversity and Equity in Kidney Health
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diversity and Equity in Kidney Health
- 900 Diversity and Equity in Kidney Health
Authors
- Zemke, Anna M., University of Washington, Seattle, Washington, United States
- Mayhand, Kiara, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
- Alicic, Radica Z., University of Washington, Seattle, Washington, United States
- Kornowske, Lindsey M., Providence Health and Services, Renton, Washington, United States
- Jones, Cami R., Providence Health and Services, Renton, Washington, United States
- Daratha, Kenn B., Providence Health and Services, Renton, Washington, United States
- Reynolds, Christina, Providence Health and Services, Renton, Washington, United States
- Nicholas, Susanne B., University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
- Petousis, Panayiotis, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
- Shpaner, Leonid, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
- Neumiller, Joshua J., Washington State University College of Pharmacy and Pharmaceutical Sciences, Spokane, Washington, United States
- Norris, Keith C., University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
- Bansal, Nisha, University of Washington, Seattle, Washington, United States
- Tuttle, Katherine R., University of Washington, Seattle, Washington, United States
Background
Chronic kidney disease (CKD) and diabetes disproportionately affect the American Indian and Alaskan Native (AI/AN) population, but knowledge of CKD risk factors and predictors of kidney function decline is limited in this population.
Methods
Health records from the Providence health system were used to identify AI/AN and White non-Hispanic (WNH) adults with diabetes in 2013-2022. Kaplan-Meier analysis was used to longitudinally assess major adverse kidney events (MAKE) defined as ≥40% estimated glomerular filtration rate (eGFR) decline, eGFR <15 mL/min/1.73 m2, dialysis or kidney transplant, and all-cause death in the AI/AN population and reference group (WNH). A Cox multivariable model was used to estimate associations of demographic, clinical and residential predictors with MAKE.
Results
The AI/AN population with diabetes (N=6,103) was younger (mean±standard deviation age 54±15 years) with higher HbA1c (mean 7.4±2.2%) compared to the WNH population (N=354,283; age 62±14 years; HbA1c 6.9±1.8%). MAKE were more frequent among AI/AN population (26%, n=1,584) compared with the reference group (24%, n=85,920). In adjusted analyses, MAKE risk was higher in the AI/AN population (p <0.0001) (Figure A). AI/AN race in the adjusted Cox model was associated with higher MAKE hazard (hazard ratio [HR] 1.20, 95% CI 1.15-1.27). In the AI/AN population, Social Vulnerability Index (HR 1.03, 95% CI 1.00-1.05) and hospitalizations (HR 1.7, 95% CI 1.54-1.89) were associated with higher, while primary care visits had lower, hazards of MAKE (HR 0.80, 95% CI 0.72-0.90) (Figure B).
Conclusion
In this real-world cohort study, we observed higher MAKE risk in the AI/AN population with adjustment for clinical and residential measures. Pragmatic studies to assess system level interventions for recognition and treatment of CKD in the AI/AN population with diabetes are needed.
Funding
- NIDDK Support