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    in Blacks

    Although it's been shown that blacks with diabetes are up to three times more likely to develop end-stage renal disease, the reasons for this aren't clear. A new study suggests that a large part of the difference is related to factors that could be modified: socioeconomic status, health behaviors, and control of blood sugar and blood pressure.

    Researchers from the Atherosclerosis Risk in Communities study, which involves almost 16,000 people in four U.S. communities, followed 1,434 patients with diabetes over a period of three years. At the beginning of the study, the 549 black participants were more likely to have higher blood pressure and blood sugar and to smoke than the 885 whites. Blacks were less likely to have health insurance, to get exercise, to earn more than $16,000 a year, and to have finished high school.

    Levels of serum creatinine, a measure of kidney function, were similar between blacks and whites at the beginning of the study, but were significantly higher in blacks at the three-year follow-up. Blacks were three times more likely to experience this early renal decline.

    The researchers looked at a variety of factors to see what predicted kidney decline. They estimated that poorer control of blood sugar alone accounted for about one-third of blacks' increased risk. Lack of blood pressure control and physical activity each accounted for 18 percent of risk, and income and education, about six percent each. The results were similar even when slightly different criteria for early decline of kidney function were used.

    The researchers concluded that differences between blacks and whites in early renal decline start early in the course of kidney disease, at a time when most patients are probably getting their care from primary-care physicians. More importantly, they concluded that "most of the excess risk for renal disease in blacks appears to be due to potentially modifiable factors, such as control of blood pressure and [blood sugar] and to socioeconomic markers related to access to health care."

    In their report in "The Archives of Internal Medicine," the authors recommend that "interventions to reduce black-white disparities in renal disease should be aimed at improving health care for blacks early in the course of their diabetes."



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