title: Epidemic of diabetic and nondiabetic renal disease among the Zuni Indians: the Zuni Kidney Project.
abstract: There is an epidemic of renal disease among the Zuni Indians. The prevalence of end-stage renal disease among the Zuni Indians is 18.4-fold and 7.4-fold higher than among European Americans and American Indians/Alaskan Natives, respectively. In contrast to other American Indian tribes, nondiabetic renal disease accounts for a significant percent of the renal disease burden among the Zuni Indians. To explore this hypothesis, a community epidemiologic study of the Zuni Pueblo was conducted. A questionnaire was administered, blood and urine samples were collected, and BP, height, and weight were measured. Neighborhood household clusters were used as the sampling frame to maximize ascertainment and minimize bias. Age and gender distributions in the sample (n = 1483) were similar to those of the eligible Zuni population (n = 9228). The prevalence, age-adjusted and gender-adjusted to the Zuni population, of incipient (0.03 < or = UACR < 0.3) albuminuria (IA) (15.0% [95% confidence interval, 13.1 to 16.9%]), and overt (UACR > or = 0.3) albuminuria (OA) (4.7% [3.6 to 5.8%]) was high. The prevalence estimates for IA and OA were higher among diabetic participants (IA: 33.6% [27.6 to 39.7%]; OA: 18.7% [13.7 to 23.7%]) than nondiabetic participants (IA: 10.8% [9.0 to 12.6%]; OA: 1.8% [1.0 to 2.5%]). However, there were more nondiabetic participants; therefore, they comprised 58.0% [51.4 to 64.6%] and 30.9% [20.0 to 41.7%] of participants with IA and OA, respectively. In contrast to most other American Indian tribes, nondiabetic renal disease contributes significantly to the overall burden of renal disease among the Zuni Indians.
authors.affiliation: Department of Internal Medicine, Nephrology ACC5, University of New Mexico, Albuquerque, NM 87131-5271, USA.
authors.forename: Vallabh O
authors.initials: VO
authors.lastname: Shah
authors.forename: Marina
authors.initials: M
authors.lastname: Scavini
authors.forename: Christine A
authors.initials: CA
authors.lastname: Stidley
authors.forename: Francesca
authors.initials: F
authors.lastname: Tentori
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Welty
authors.forename: Jean W
authors.initials: JW
authors.lastname: MacCluer
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Narva
authors.forename: Arlene
authors.initials: A
authors.lastname: Bobelu
authors.forename: Carleton P
authors.initials: CP
authors.lastname: Albert
authors.forename: David S
authors.initials: DS
authors.lastname: Kessler
authors.forename: Antonia M
authors.initials: AM
authors.lastname: Harford
authors.forename: Craig S
authors.initials: CS
authors.lastname: Wong
authors.forename: Alexis A
authors.initials: AA
authors.lastname: Harris
authors.forename: Susan
authors.initials: S
authors.lastname: Paine
authors.forename: Philip G
authors.initials: PG
authors.lastname: Zager
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000419:Albuminuria / Q000208:ethnology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003928:Diabetic Nephropathies / Q000208:ethnology*; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D007676:Kidney Failure, Chronic / Q000208:ethnology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution