title: Racial/ethnic differences in the prevalence of proteinuric and nonproteinuric diabetic kidney disease.
abstract: OBJECTIVE
  To examine racial/ethnic differences in the prevalence of diabetic kidney disease (DKD), with and without proteinuria, in an outpatient health care organization.
  
  
  METHODS
  We examined electronic health records for 15,683 persons of non-Hispanic white (NHW), Asian (Asian Indian, Chinese, and Filipino), Hispanic, and non-Hispanic black (NHB) race/ethnicity with type 2 diabetes and no prior history of kidney disease from 2008 to 2010. We directly standardized age- and sex-adjusted prevalence rates of proteinuric DKD (proteinuria with or without low estimated glomerular filtration rate [eGFR]) or nonproteinuric DKD (low eGFR alone). We calculated sex-specific odds ratios of DKD in racial/ethnic minorities (relative to NHWs) after adjustment for traditional DKD risk factors.
  
  
  RESULTS
  Racial/ethnic minorities had higher rates of proteinuric DKD than NHWs (24.8-37.9 vs. 24.8%) and lower rates of nonproteinuric DKD (6.3-9.8 vs. 11.7%). On adjusted analyses, Chinese (odds ratio 1.39 for women and 1.56 for men), Filipinos (1.57 for women and 1.85 for men), Hispanics (1.46 for women and 1.34 for men), and NHBs (1.50 for women) exhibited significantly (P < 0.01) higher odds of proteinuric DKD than NHWs. Conversely, Chinese, Hispanic, and NHB women and Hispanic men had significantly lower odds of nonproteinuric DKD than NHWs.
  
  
  CONCLUSIONS
  We found novel racial/ethnic differences in DKD among patients with type 2 diabetes. Racial/ethnic minorities were more likely to have proteinuric DKD and less likely to have nonproteinuric DKD. Future research should examine diverse DKD-related outcomes by race/ethnicity to inform targeted prevention and treatment efforts and to explore the etiology of these differences.
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford,CA, USA.
authors.forename: Vivek
authors.initials: V
authors.lastname: Bhalla
authors.forename: Beinan
authors.initials: B
authors.lastname: Zhao
authors.forename: Kristen M J
authors.initials: KM
authors.lastname: Azar
authors.forename: Elsie J
authors.initials: EJ
authors.lastname: Wang
authors.forename: Sarah
authors.initials: S
authors.lastname: Choi
authors.forename: Eric C
authors.initials: EC
authors.lastname: Wong
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Fortmann
authors.forename: Latha P
authors.initials: LP
authors.lastname: Palaniappan
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D001213:Asian / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000208:ethnology; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000208:ethnology*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D011507:Proteinuria / Q000453:epidemiology* / Q000208:ethnology*; D012307:Risk Factors; D044465:White People / Q000706:statistics & numerical data