Renal disease among the Eastern Band of Cherokee Indians

To ascertain the incidence and prevalence of ESRD in the Eastern Band of Cherokee in the IHS user population from 1978 to 1988 and to determine what proportion of ESRD and chronic renal failure is attributable to diabetes.

Cases were identified from three IHS data sources and from death records obtained from the North Carolina Bureau of Health Statistics. Chronic renal insufficiency was defined as an individual having a serum creatinine of > or = 176.8 microM that remained at that level for a sustained period. An ESRD case was defined as one in which dialysis was required to sustain life, regardless of whether treatment was actually implemented. Data were obtained from chart review and included date of diagnosis, maximum serum creatine level attained, diabetes status, and certain demographic data.

Twenty-two (88%) cases of ESRD were attributable to diabetes. The average annual incidence of ESRD during the study period was much higher than that in the U.S. white population and that of Native Americans. The incidence of ESRD caused by diabetes was 2.5 times higher than that reported in the U.S. Native American population affected by diabetes. Degree of Indian inheritance did not appear to be related to prevalence of diabetic renal disease in individuals having diagnosed diabetes.

The proportion of ESRD attributable to diabetes indicates that primary prevention of diabetes may be the best method of preventing ESRD in this population.