Diabetic renal disease in transitional and disadvantaged populations

Abstract

SUMMARY:Diabetes mellitus has reached epidemic proportions throughout much of the world, and people from developing countries and disadvantaged groups from developed countries are affected disproportionately. Not only is diabetes more common in these populations, but it develops at an earlier age. Accordingly, patients have more years of life in which to develop the chronic complications of diabetes and the risk of complications is often further enhanced by limited access to health care. Renal disease is a frequent consequence of diabetes in these populations, and a number of factors related to poverty, malnutrition and accelerated lifestyle changes may lead to even greater rates in the future.

Exploring the pathways leading from disadvantage to end-stage renal disease for Indigenous Australians

“…High ESRD rates in indigenous populations have been related to the growing epidemic of type 2 diabetes (Dyck, 2001;Nelson, 2001). Surveys in Australian Aboriginal communities have confirmed a very high prevalence of impaired glucose tolerance (IGT) and type 2 diabetes (Daniel, Rowley, McDermott, & O'Dea, 2002).…”

“…We have already discussed the attribution of high ESRD rates among indigenous populations to the growing epidemic of type 2 diabetes (Dyck, 2001;Nelson, 2001). The 'thrifty genotype' hypothesis suggests a possible explanation for the epidemic of type 2 diabetes in indigenous populations, as they make the rapid transition from traditional lifestyles to western diets and lifestyles (Neel, 1962).…”

“…Genetic studies have reported possible locations of 'renal failure susceptibility genes' in indigenous populations (Nelson, 2001). Two strategies have been widely used in searches for genetic linkage (Freedman et al, 1998).…”

“…In nephrology, this line of research has focused predominantly on genes coding for the reninangiotensin system, which plays a central role in blood pressure regulation (Nelson, 2001). It has been postulated that, in Caucasians, the DD genotype of the angiotensin-I-converting enzyme (ACE) gene is an independent risk factor for renal disease (Dudley, Keavney, Stratton, Turner, & Ratcliffe, 1995), associated with an increased rate of progression of kidney damage in diabetes (Parving et al, 1996;Yoshida et al, 1996) and IgA glomerulonephritis (Harden et al, 1995).…”

An Association of Maternal Age and Birth Weight with End-Stage Renal Disease in Saskatchewan. Sub-Analysis of Registered Indians and Those with Diabetes

“…Based on this and work done among the Pima [17, 18], we have speculated that an ancient survival advantage that promoted healthy pregnancies, now contributes to a diabetogenic intrauterine environment that leads to an increased risk for T2DM among certain indigenous populations (the Hefty Fetal Type Hypothesis [16]). Nelson has additionally shown that diabetic Pima subjects whose mothers had diabetic pregnancies are more likely to have microalbuminuria [19, 20]. Thus, there is emerging evidence that disparate intrauterine mechanisms leading to both LBW and HBW can contribute to the later development of renal disease.…”