Sustained Lower Incidence of Diabetes-Related End-Stage Kidney Disease Among American Indians and Alaska Natives, Blacks, and Hispanics in the U.S., 2000-2016

Diabetes Care. 2020 Sep;43(9):2090-2097. doi: 10.2337/dc20-0495. Epub 2020 Jul 2.


Objective: Diabetes-related end-stage kidney disease (ESKD-D) disproportionately affects U.S. racial/ethnic minority populations compared with whites. However, from 1996 to 2013, ESKD-D incidence among American Indians and Alaska Natives (AIANs) and blacks declined. We assessed recent ESKD-D incidence data to determine whether trends by race/ethnicity have changed since 2013.

Research design and methods: United States Renal Data System data from 2000 to 2016 were used to determine the number of whites, blacks, AIANs, Asians, and Hispanics aged ≥18 years with newly treated ESKD-D (with diabetes listed as primary cause). Using census population estimates as denominators, annual ESKD-D incidence rates were calculated and age adjusted to the 2000 U.S. standard population. Joinpoint regression was used to analyze trends and estimate an average annual percent change (AAPC) in incidence rates.

Results: For adults overall, from 2000 to 2016, age-adjusted ESKD-D incidence rates decreased by 53% for AIANs (66.7-31.2 per 100,000, AAPC -4.5%, P < 0.001), by 33% for Hispanics (50.0-33.3, -2.1%, P < 0.001), and by 20% for blacks (56.2-44.7, -1.6%, P < 0.001). However, during the study period, age-adjusted ESKD-D incidence rates did not change significantly for Asians and increased by 10% for whites (15.4-17.0, 0.6%, P = 0.01). In 2016, ESKD-D incidence rates in AIANs, Hispanics, and blacks were ∼2.0-2.5 times higher than whites.

Conclusions: ESKD-D incidence declined for AIANs, Hispanics, and blacks and increased for whites. Continued efforts might be considered to reverse the trend in whites and sustain and lower ESKD-D incidence in the other populations.

Publication types

  • Historical Article

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Alaskan Natives / statistics & numerical data*
  • American Indian or Alaska Native / statistics & numerical data*
  • Black or African American / statistics & numerical data*
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / ethnology
  • Diabetic Nephropathies / epidemiology
  • Diabetic Nephropathies / ethnology*
  • Female
  • Hispanic or Latino / statistics & numerical data*
  • History, 20th Century
  • History, 21st Century
  • Humans
  • Incidence
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / ethnology*
  • Male
  • Middle Aged
  • United States / epidemiology