Major Adverse Kidney Events in the American Indian or Alaska Native Population with Diabetes

KEY POINTS: Knowledge of the risk of major adverse kidney events in the American Indian or Alaska Native population with diabetes is limited. Compared with the non-Hispanic White population, the American Indian or Alaska Native population was younger with poorer glycemic control. This population had a 20% higher risk of major adverse kidney events with social drivers of health and health care utilization as key predictors. BACKGROUND: CKD and diabetes disproportionately affect the American Indian (AI) or Alaska Native (AN) population, but understanding of major adverse kidney events (MAKE) in this population is limited. METHODS: Electronic health records from the Providence health system identified the AI or AN adult population with diabetes during 2013-2022. A 1-year window surrounding diabetes cohort entry was used to collect baseline data. Kaplan-Meier analyses assessed MAKE (≥40% eGFR decline, eGFR <15 ml/min per 1.73 m 2 , dialysis or kidney transplant, and all-cause death) with propensity score matching (1:3) of AI or AN people to reference individuals (non-Hispanic White) by demographics and clinical characteristics. Cox proportional hazards modeling estimated associations between demographic, clinical, social, and health care utilization variables and MAKE. RESULTS: The AI or AN population ( N =6103) was younger (mean±SD age 54±15 years) with higher hemoglobin A1c (mean 7.4±2.2 mg/dl) compared with the reference population ( N =354,283; age 62±14 years; hemoglobin A1c 6.9%±1.8%). During a median follow-up of 4.1 (interquartile range, 2.0-6.4) years, the AI or AN population experienced a higher frequency of MAKE (26%, n =1614) than the reference population (24%, n =85,920). With propensity score matching, MAKE survival estimates were significantly lower in the AI or AN population ( P < 0.0001). In the adjusted Cox model, increased MAKE risk was observed for the AI or AN population (versus reference population, hazard ratio [HR] 1.20, 95% confidence interval [CI], 1.15 to 1.27), higher social vulnerability index (HR, 1.05; 95% CI, 1.05 to 1.05), and hospitalization (HR, 1.98; 95% CI, 1.95 to 2.01), while more primary care visits were associated with lower MAKE risk (HR, 0.78; 95% CI, 0.77 to 0.79). CONCLUSION: The risk of MAKE was significantly increased in the AI or AN population with diabetes. Social factors and health care utilization importantly contributed to risk prediction for MAKE.