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Risks for CKD in Asian Americans

September 6, 2023

In the United States, the burden of kidney disease falls disproportionately on racial and ethnic minority groups, with Asian Americans being twice as likely to develop kidney failure as Caucasian Americans.

The Dominance of Diabetes

Diabetes takes the lead as the primary cause of kidney disease, accounting for approximately 43 percent of all new cases annually. Diabetes wreaks havoc on the blood vessels within the kidneys, sometimes impairing their ability to cleanse the blood. Consequently, individuals with diabetes constitute the fastest-growing segment among kidney dialysis patients and transplant recipients.

The Two Faces of Diabetes

There are two types of diabetes. Type 1 diabetes occurs when the pancreas does not produce insulin and is typically diagnosed in young children. In contrast, Type 2 diabetes arises when the body becomes resistant to insulin. Historically, it affected mostly adults, but an increasing number of children are now diagnosed with Type 2 diabetes due to excess weight and insufficient physical activity.

It is challenging to pinpoint the current prevalence of Type 2 diabetes among Asian Americans, but research indicates that it is a growing concern within this demographic. Diabetes ranks as the fifth leading cause of death for Asian Americans in the 45 to 64 age range.

The Shift from Traditional Diets

Asian immigrants to the United States who adopt an American diet face a heightened risk of diabetes. Studies reveal that the traditional Asian diet, rich in plant and fish-based foods, has given way to a diet higher in calories and fat, with lower fiber content. Comparisons between Japanese individuals living in Japan and those residing in Hawaii have shown that Hawaiian Japanese have higher obesity rates and double the incidence of Type 2 diabetes.

Another contributing factor is the shift from physically demanding lifestyles to sedentary ones. In the past, physical labor was a routine part of many Asians’ daily lives, whereas today, most Asian Americans engage in little to no physical activity.

Lifestyle Changes for Risk Reduction

Risk factors for diabetes are linked to both genetics and lifestyle. While one’s genetic makeup is fixed, adopting a healthier lifestyle can mitigate risk factors.

Starting with maintaining a healthy weight, as being overweight is a significant diabetes risk factor. Additionally, the distribution of excess weight on the body matters, with those carrying it in the midsection or upper body at higher risk of Type 2 diabetes.

A study supported by the National Institutes of Health (NIH) demonstrated that diet and exercise could reduce the risk of developing Type 2 diabetes. One group in the study, which engaged in moderate daily exercise and followed a healthier diet, reduced their Type 2 diabetes risk by 58%.

Testing: The Key to Early Diagnosis and Treatment

The National Kidney Foundation (NKF) has issued guidelines for individuals at high risk of chronic kidney disease, including Asian Americans and Pacific Islanders. Other high-risk groups comprise individuals with diabetes, high blood pressure, a family history of high blood pressure, older Americans, African Americans, American Indians, and Hispanic Americans.

Andrew Levey, Chief of the Division of Nephrology at Tufts-New England Medical Center and chair of the group that developed the guidelines, emphasized, “We now realize that earlier stages of the disease are much more common than previously thought. If the diagnosis is made earlier and if kidney disease is treated earlier, some of the complications of chronic kidney disease can be prevented, including the progression to kidney failure and the development of heart disease.”

Individuals in high-risk groups should request their healthcare provider to perform three essential tests:

  • A blood pressure check
  • An estimate of glomerular filtration rate (GFR), which measures kidney function
  • A dipstick test for protein in the urine

If test results indicate signs of kidney disease, the healthcare provider will monitor the patient, prescribe medication if necessary, recommend a special diet, and suggest other lifestyle changes.

It’s crucial to undergo regular testing and share this information with friends and family to raise awareness among Asian Americans about the heightened risks of diabetes and chronic kidney disease, with the aim of reversing these trends.

Asian American Population Statistics

  • As of July 2001, the estimated number of Asian Americans was 12.5 million, constituting 4.4% of the total US population. This group is experiencing rapid growth, more than three times the growth rate of the entire US population.
  • As of July 2001, the estimated number of individuals identifying as native Hawaiian and other Pacific Islander exceeded 935,000.
  • The states with the largest Asian American populations are California (4.2 million, the highest number), New York, Hawaii, Texas, and New Jersey. Hawaii hosts the largest population of native Hawaiians and other Pacific Islanders.

Sources:

  • Hooper LM, Bennett CE. The Asian and Pacific Islander population in the United States: March 1997 (update). In Current population reports: Population characteristics. 1998; Washington, DC: U.S. Department of Commerce.
  • Centers for Disease Control and Prevention. Chronic diseases in minority populations: African-Americans, American Indians and Alaska Natives, Asians and Pacific Islanders, Hispanic Americans. 1994; Atlanta: Centers for Disease Control and Prevention.
  • Fujimoto WY. Diabetes in Asian and Pacific Islander Americans. In National Diabetes Data Group, Diabetes in America 1995;(NIH Publication No. 95-1468, 2nd ed., pp. 661-681). Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.
  • Carter JS, Pugh JA, Monterrosa A. Non-insulin-dependent diabetes mellitus in minorities in the United States. Annals of Internal Medicine. 1996;125(3):221-232.
  • Huang B, Rodriguez BL, Burchfiel CM, Chyou P, Curb JD, Yano K. Acculturation and prevalence of diabetes among Japanese-American men in Hawaii. American Journal of Epidemiology. 1996;144(7):674-681.
  • Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine. 2002;346:393-403.
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