Diabetes, Hypertension, and Kidney Disease in the Pima Indians

  • William C. Knowler
  • Robert G. Nelson
  • David J. Pettitt

Abstract

Hypertension and kidney disease are well-known concomitants of both type 1 and type 2 diabetes mellitus. Hypertension, kidney disease, and diabetes are associated with each other, but the associations vary between populations, and the causal interpretations, especially regarding hypertension and diabetic nephropathy, are controversial. The complications of diabetes have been studied extensively among the Pima Indians of Arizona, U.S.A. In this chapter, we describe the epidemiology of diabetic renal disease and its relationship with hypertension in the Pima Indians.

Keywords

Glomerular Filtration Rate Diabetic Nephropathy High Blood Pressure Impaired Glucose Tolerance Normal Glucose Tolerance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Knowler WC, Bennett PH, Hamman RF, Miller: Diabetes incidenœ and prevalence in Pima lndians: a 19-fold greater incidence than in Rochester, Minnesota. Am J Epidemiol 108:497–505,1978.PubMedGoogle Scholar
  2. 2.
    Knowler WC, Pettitt DJ, Saad MF, Bennett PH: cabetes mellitus m the Pima Indians: incidence, risk factors, and pathogenesis. Diabetes/Metabolism Reviews 6:1–27,1990.PubMedCrossRefGoogle Scholar
  3. 3.
    Diabetes mellitus: report of a WHO study group. WHO Technical Report Series 727. Geneva, World Health Organization, 1985.Google Scholar
  4. 4.
    Kunzelman CL, Knowler WC, Pettitt DJ, Bennett PH: Inddence of nephropathy in type 2 diabetes mellitus in the Pima Indians. Kidney Int 35:681–687,1989.PubMedCrossRefGoogle Scholar
  5. 5.
    Nelson RG, Kunzelman CL, Pettitt DJ, Saad MF, BennettPH, Knowler WC: Albuminuria in Type 2 (non-insulin-dependent) diabetes mellitus and impaired glucose tolerance in Pima Indians. Diabetologia 32:870–876.1989.PubMedCrossRefGoogle Scholar
  6. 6.
    Saad MF, Knowler WC, Pettitt DJ, Nelson RG, Mott DM, Bennett PH: Insulin and hypertension: relationship to obesity and gjucose intolerance in Pima Indians. Diabetes 39:1430–1435,1990.PubMedCrossRefGoogle Scholar
  7. 7.
    Nelson RG, Bennett PH, Beck GJ, Tan M, Knowler WC, Mitch WE, Hirschman GH, Myers BD, forthe Diabetic Renal Disease Study: Development and progression of renal disease in Pima Indians with non-insulin-dependent diabetes mellitus. N Engl J Med 335:1636–1642,1996.PubMedCrossRefGoogle Scholar
  8. 8.
    Knowler WC, Bennett PH, Bottazzo GF, Doniach D: Islet cell antibodies and diabetes mellitus in Pima Indians. Diabetologia 17:161–164,1979.PubMedCrossRefGoogle Scholar
  9. 9.
    Myers BD, Nelson RG, Williams GW, Bennett PH, Hardy SA, Berg RL, Loon N, Knowler WC, Mitch WE: Glonierular function m Pima Indians wim non-insulm J Clin Invest 88:524–530,1991.PubMedCrossRefGoogle Scholar
  10. 10.
    Mogensen CE, Christensen CK, Vittingfius E: the stages in diabetic renal disease: with emphasis on the stageof incipient diabetic nephropathy. Diabetes [suppl 2] 32:64–78,1983.Google Scholar
  11. 11.
    Nelson RG, Knowler WC, Pettitt DJ, Saad MF, Charles MA, Bennett PH: Assessment of risk of overt nephropathy in diabetic patients from albumin excretion in untimed urine specimens. Arch Int Med 151:1761–1765,1991.CrossRefGoogle Scholar
  12. 12.
    Nelson RG, Knowler WC, Pettitt DJ, Hanson RL, Bennett PH: Incidence and determinants of elevated urinary albumin excretion in Pima Indians with NIDDM Diabetes Care 18:182–187,1995.PubMedCrossRefGoogle Scholar
  13. 13.
    Andersen AR, Christiansen JS, Andersen JK, Kreiner S, Deckert T: Diabetic nephropathy in Type 1 (insulin-dependent) diabetes: an epidemiological study. Diabetologia 25:496–501,1983.PubMedCrossRefGoogle Scholar
  14. 14.
    Myers BD, Nelson RG, Tan M, Beck GJ, Beimett PH, Knowler WC, Blown K, Mitch WE: Progression of overt nephropathy in non-insulin-dependent diabetes. Kidney Int 47:1781–1789,1995.PubMedCrossRefGoogle Scholar
  15. 15.
    Nelson RG, Knowler WC, McCance DR, Sievers ML, Pettitt DJ, Charles MA, Hanson RL, Liu QZ, Bennett PH: Determinants of end-stage renal disease in Pima Indians with type 2 (non-insulin-dependent) dabetes mellitus and proteinuria. Diabetologia 36:1087–1093,1993.PubMedCrossRefGoogle Scholar
  16. 16.
    Krolewski AS, Wanam JH, Cristheb AR, Busick EJ, Kahn C: The changing natural history of nephropathy in Type 1 diabetes. Am JMed 78:785–793,1985.Google Scholar
  17. 17.
    Humphrey LL, Ballard DJ, Frohnert PP, Chu C-P, O’Fallon WM, Palumbo PJ: Chronic renal failure in non-insulin-dependent diabetes mellitus: a population-based study in Rochester, Minnesota. Ann Intern Med 111:788–796,1989.PubMedCrossRefGoogle Scholar
  18. 18.
    Nelson RG, Sievers ML, Knowler WC, Swinbum BA, Pettitt DJ, Saad MF, Garrison R, Liebow IM, Howard BV, Bennett PH: Low incidence of fatal coronary heart disease in Pima Indians despite higfi prevalence of non-insulin-dependent diabetes. Circulation 81:987–995,1990.PubMedCrossRefGoogle Scholar
  19. 19.
    Nelson RG, Newman JM, Knowler WC, Sievers ML, Kunzelman CL, Pettitt DJ, Moffett CD, Teutsch SM, Bennett PH: Incidence of end-stage renal disease in Type 2 (non-insulin-dependent) diabetes mellitus in Pima Indians. Diabetologia 31:730–736,1988.PubMedCrossRefGoogle Scholar
  20. 20.
    Hasslacher C, Ritz E, Wahl P, Michael C: Similar risks of nephropathy in patients with type I and type II diabetes mellitus. Nephrol Dial Transplant 4:859–863,1989.PubMedGoogle Scholar
  21. 21.
    Nelson RG, Knowler WC, Pettitt DJ, Saad MF, Bennett PH: Diabetic kidney disease in Pima Indians. Diabetes Care 16:335–341,1993.PubMedCrossRefGoogle Scholar
  22. 22.
    Robbins DC, Knowler WC, Lee ET, Yen J, Go OT, Welty T, Fabsitz R, Howard BV: Regional differences in albuminuria among American Indians: an epidemic of renal disease. Kidney Int 49:557–563,1996.PubMedCrossRefGoogle Scholar
  23. 23.
    Pettitt DJ, Saad MF, Bennett PH, Nelson RG, Knowler WC: Familial predisposition to renal disease in two generations of Pima Indians with Type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia 33:438–443,1990.PubMedCrossRefGoogle Scholar
  24. 24.
    Nelson RG, Pettitt DJ, de Courten MP, Hanson RL, Knowler WC, Bennett PH: Parental hypotension and proteinuria in Pima Indians with MDDM Diabetologia 39:433–438,1996.PubMedCrossRefGoogle Scholar
  25. 25.
    Imperatore G, Hanson RL, Petitt DJ, Kobes S, Bennett PH, Knowler WC, and the Pirna Diabetes Genes Group: Sib-pair linkage analysis for susceptibility genes for microvascular complications among Pima Indians with type 2 diabetes mellitus. Diabetes (in press)Google Scholar
  26. 26.
    de Courten MP, Ksiazek TG, Rollin PE, Kahn AS, Daily PJ, Knowler WC: Sero-prevalence study of hantavirus antibodies in Pima Indians with renal disease. J Infectious Dis 171:762–763,1995.CrossRefGoogle Scholar
  27. 27.
    Nelson RG, Pettitt DJ, Carraher MI, Baird HR, Knowler WC: Effect of proteinuria on mortality in NIDDM Diabetes 37:1499–1504,1988.PubMedCrossRefGoogle Scholar
  28. 28.
    Deckert T, Feldt-Rasmussen B, Borch-Johnsen K, Jensen T, Kofoed-Enevoldsen A; Albuminuria reflects widespread vascular damage. The Steno hypothesis. Diabetologia 32:219–226,1989.PubMedCrossRefGoogle Scholar
  29. 29.
    Kamenetzky SA, Bennett PH, Dippe SE, Miller M, LeCompte PM: A clinical and histologic study of diabetic nephropathy in the Pima Indians. Diabetes 23:61–68,1974.PubMedGoogle Scholar
  30. 30.
    Schmidt K, Pesos C, liu Q, Nelson RG, Bennett PH, Kamitschnig H, Striker LJ, Striker GE: Large glomerular size in Pima Indians: lack of change with diabetic nephropathy. J Am Soc Nephrol 3:229–235, 1992.PubMedGoogle Scholar
  31. 31.
    Pagalunan ME, Miller PL, Jumping-Eagle S, Nelson RG, Myers BD, Rennke HG, Coplon NS, Sun L, Meyer TW: Podocyte loss and progressive glomerular injury in type II diabetes. J Clin Invest 99:342–348, 1997.CrossRefGoogle Scholar
  32. 32.
    Saad MF, Lillkoja S, Nyomba BL, Castillo C, Ferraro R, DeGregoria M, Ravaussin E, Knowler WC, Bennett PH, Howard BV, Bogardus C: Racial differences in the relation between blood pressure and insulin resistance. N Engl J Med 324:733–739,1991.PubMedCrossRefGoogle Scholar
  33. 33.
    Mathiesen ER, Ronn B, Jensen T, Storm B, Deckert T: Relationship between blood pressure and urinary albumin excretion in development of microalbuminuria. Diabetes 39:245–249,1990.PubMedCrossRefGoogle Scholar
  34. 34.
    Viberti CG, Keen H, Wiseman MJ: Raised arterial pressure in parents of proteinuric insulin-dependent diabetics. Br Med J 295:551–517,1987.CrossRefGoogle Scholar
  35. 35.
    Krokwski AS, Canessa M, Warram JH, Laffel LMB, Christlieb AR, Knowler WC, Rand LI: Predisposition to hypertension and susceptibility to renal disease in insulin-dependent diabetes mellitus. N Eng J Med 318:140–145,1988.CrossRefGoogle Scholar
  36. 36.
    Knowler WC, Nelson RG, Pettitt DJ: Diabetes, hypertension, and kidney disease in the Pima Indians compared with other populations. In Mogensen CE, ed: The Kidney and Hypertension in Diabetes Mellitus, 2nd ed., Kluwer Academic Publishers, Boston, 1994, pp. 53–62.CrossRefGoogle Scholar
  37. 37.
    Knowler WC, Bennett PH, Ballintine EJ: Increased incidence of retinopathy in diabetics with elevated blood pressure: a six-year followup study in Pima Indians. N Eng J Med 302:645–650,1980.CrossRefGoogle Scholar
  38. 38.
    Liu QZ, Knowler WC, Nelson RG, Saad MF, Charles MA, Liebow IM, Bennett PH, Pettitt DJ: Insulin treatment, endogenous insulin concentration, and ECG abnormalities in diabetic Pima Indians: cross-sectional and prospective analyses. Diabetes 41:1141–1150,1992.PubMedCrossRefGoogle Scholar
  39. 39.
    Nelson RG, Pettitt DJ, Baird HR, Charles MA, Liu QZ, Bennett PH, Knowler WC: Prediabetic blood pressure predicts urinary albumin excretion after the onset of type 2 (non-insulin-dependent) diabetes mellitus in Pima Indians. Diabetologia 36:998–1001,1993.PubMedCrossRefGoogle Scholar
  40. 40.
    McCance DR, Hanson RL, Pettitt DJ, Jacobsson LTH, Bennett PH, Bishop DT, Knowler WC: Diabetic nephropathy: a risk factor for diabetes in offspring Diabetologia 38:221–226,1995.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1998

Authors and Affiliations

  • William C. Knowler
    • 1
  • Robert G. Nelson
    • 1
  • David J. Pettitt
    • 1
  1. 1.National Institute of Diabetes and Digestive and Kidney DiseasesPhoenixUSA

Personalised recommendations