Kaiser Permanente study finds highest rates in Asians, with variations among ethnic subgroups
Among adults with diabetes who had kidney function perceived to be normal, a marker for early diabetic kidney disease was more commonly seen in Asian adults than in white, Black, or Latino adults, a new Kaiser Permanente study found.
The research, published in Diabetes Care, included 79,184 people ages 45 to 74 in the Kaiser Permanente Northern California (KPNC) Diabetes Registry. All the patients had kidney function that was perceived to be normal based on a widely used blood test. However, when the researchers reviewed the patients’ electronic health records, they found about 18% had an elevated urine albumin level, with distinct racial and ethnic variations.
“Albumin in the urine is the first tell-tale sign a patient has diabetic kidney disease, because its levels can be high even when the test we widely use, estimated glomerular filtration rate, or eGFR, is perceived to be normal,” said co-senior author Sijie Zheng, MD, PhD, an adjunct investigator with the Kaiser Permanente Division of Research and a nephrologist with The Permanente Medical Group. “Testing for the urine albumin provides opportunity for doctors to identify patients with early kidney disease.”
Overall, 21% of Asian and Pacific Islander adults had high levels of albumin in their urine compared with 18.6% of Black adults, 17.6% of Hispanic adults and 16.8% of white adults. But within the Asian and Pacific Islander populations, differences among ethnic subgroups were seen.
The study found 27.9% of Native Hawaiian/Pacific Islander, 25.3% of Filipino adults, and 14.6% of South Asian adults had high levels of albumin in their urine. Among Japanese, Southeast Asian, and Chinese adults, there was little variation, with about 18% to 19% showing high levels. The findings support previous reports showing ethnic variations in albuminuria in Asians with diabetic kidney disease.
Identifying differences within this large population can help our physicians provide the best care to people of Asian heritage.
— Joan C. Lo, MD
“It is important for providers to remember that each patient has a unique cultural, social, and genetic story which should be considered when making clinical decisions,” said lead author Uchenna Nwosu, MD, a nephrology fellow at the University of California, San Francisco. Nwosu conducted this research during his chief residency at Kaiser Permanente Oakland.
This study adds to growing body of evidence in support of research that looks at Asian subgroups rather than Asians as a whole.
“This study is part of a broader area of research on the health of our Asian communities,” said co-senior author Joan C. Lo, MD, a research scientist at the Division of Research. “Identifying differences within this large population can help our physicians provide the best care to people of Asian heritage.”
“A lot of people think of Asian and Pacific Islanders as a monotypic group,” added Zheng. “But it is a very diverse population with people from various geographic locations with different heritages, different dietary habits, and different socioeconomic status. This misconception that all Asians are alike has led to a big research void. At Kaiser Permanente we are in a great position to look at variations in albuminuria by race and ethnicity because of our integrated health care system, diverse population and our electronic health records.”
Albumin is made by the liver and released into the bloodstream. Healthy kidneys keep the albumin in the blood and injured kidneys leak albumin from blood into urine. The American Diabetes Association recommends people with diabetes have an annual albumin urine test to help catch diabetic kidney disease as early as possible. More than 80% of KPNC’s patients with diabetes receive this test annually. But rates vary across the country. A study published in 2021 in Hypertension found screening rates that ranged from 12.3% to 74.5% nationwide.
About 1 in 3 adults with diabetes will develop chronic kidney disease. That’s because the high blood sugar levels that are a marker of diabetes injures kidneys. Initially, the loss of kidney function is unlikely to cause many symptoms. But, over years, or decades, as the kidneys slowly become more damaged, people develop symptoms such as nausea, vomiting, fatigue, swelling of the feet and ankles, and high blood pressure. That’s why it’s important to identify it as early as possible.
“Early diabetic kidney disease is a condition we can manage with medication and lifestyle modification,” said Zheng. “Knowing there are higher risk groups creates potential for more awareness about screening and interventions.”
The study was funded by the KPNC Community Health Program.
Co-authors include Jeanne A. Darbinian, MPH, of the Division of Research; Kenneth K. Chen, MD, and Hasmik Arzumanyan, MD, of The Permanente Medical Group; and Billy Zeng, MD, of Kaiser Permanente Oakland.
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About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 600-plus staff is working on more than 450 epidemiological and health services research projects. For more information, visit divisionofresearch.kaiserpermanente.org or follow us @KPDOR.
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