Indigenous health: update on the impact of diabetes and chronic kidney disease

PURPOSE OF REVIEW: With respect to chronic diseases such as diabetes and its complications, indigenous populations are known to suffer from poor health outcomes in comparison with whites. The purpose of this review is to highlight recent epidemiologic and intervention studies that have occurred in the areas of diabetes and renal disease among indigenous populations. RECENT FINDINGS: The burden of diabetes is increasing among younger indigenous groups with epidemic levels of end-stage kidney disease. As dialysis therapy has contributed to prolong life among indigenous patients, cardiovascular disease has now become the leading cause of mortality in these populations. Clear preventive intervention strategies to improve rates of progression to end-stage kidney disease are not prevalent nor are they emerging over time. Access to kidney transplantation is also reduced among indigenous populations in Australia, New Zealand, the USA and Canada. Reasons for this disparity are unclear but likely multifactorial. SUMMARY: Diabetes and its complications have produced a health crisis among indigenous populations. The impact on healthcare systems in countries where these indigenous populations reside will be substantial unless significant efforts are made to improve diabetic renal disease outcomes in the near future.