Mechanisms of renal disease in indigenous populations: influences at work in Canadian indigenous peoples

Canadian aboriginal people experience end‐stage renal disease at rates 2.5–4 times higher than those found in the general population. Up to 60% of cases are due to diabetic end‐stage renal disease, while most of the remainder are caused by a variety of types of glomerulonephritis. The greatest increase in cases of end‐stage renal disease among aboriginal people since 1981 has been observed in those with diabetes. There appear to be three major contributing influences to the increase in diabetic end‐stage renal disease among Canadian aboriginal people. First, the rates of type 2 diabetes mellitus have increased from virtually zero to several times those seen in the general population in less than 60 years. Second, aboriginal people with diabetes have seven times the rate of diabetic end‐stage renal disease compared with their non‐aboriginal counterparts. Finally, birth rates among aboriginal people are higher than in any other segment of the population. An epidemic of diabetic end‐stage renal disease is the most important nephrological issue facing Canadian aboriginal people and threatens to overwhelm health care resources in many parts of the country unless effective early recognition and prevention programmes are established.