Donica Ghahate, AS
Jeanette Bobelu, AS
Phillip Sandy, AS
Bruce Struminger, MD
Thomas Faber, MD
Vallabh Shah, PhD.
University of New Mexico Health Sciences Center, Albuquerque, NM and Zuni IHS Hospital.
The Native Americans are socioeconomically disadvantaged population faces a major public health challenge from growing health disparities including Zunis. Changing lifestyles have led to decreased physical activity and increased caloric intake with high consumption of fast foods, high-calorie drinks, and alcohol. Consequently, the Zuni are experiencing interrelated epidemics of obesity, diabetes, hypertension, and kidney disease. The Zuni Kidney Project (ZKP) has described the epidemic of kidney disease and subsequent investigation of Genetics of Kidney Disease in Zuni Indians (GKDZI) described the heritability of kidney disease and its intermediate phenotypes. Recently, through (Patient Center Outcomes Research Institute (PCORI) funded home-base kidney care (HBKC), we rescreened 314 Zuni participants.
In order to test the hypothesis that the Cardiometabolic risk factors including diabetes and chronic kidney disease would progress over time, we performed an analysis of subjects in HBKC who participated in both ZKP and GKDZI.
Three hundred and fourteen individuals who participated in HBKC were studied at 3 time points at a mean interval of 8.6 years (range 2.5-13 years). Forty six percent of this cohort was female; mean age at the 1st study point was 30.8 years. The table shows the progression of metabolic risk factors over time.
The development of ESRD in 6 individuals in this cohort underscores the high incidence of renal disease previously described by our group in this population. In addition microalbuminuria was noted in 31.2% individuals at the time point I, 54.9% at time point II and 71.5% at time point 3. 105 participants were teenagers at the first study point and adults at the second and third time point. This group had particularly high rates of progression of obesity, 42.9% were overweight or obese at time point I, 63.7% at time point II and 72.4% at time point III.
This analysis of a cohort of individuals from the PCORI studied at 3 time points over up to 14.3 years shows a progression of Cardiometabolic factors including diabetes and obesity. These findings reinforce the need for interventions to modify these risk factors for CKD progression as supported by and PCORI pilot HBKC care in this high risk population, particularly amongst the young adult Zuni.