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Prevalence and progression of diabetic nephropathy in South Asian, white European and African Caribbean people with type 2 diabetes: A systematic review and meta‐analysis
Author(s) -
Jadawji Chandni,
Crasto Winston,
Gillies Clare,
Kar Debasish,
Davies Melanie J.,
Khunti Kamlesh,
Seidu Samuel
Publication year - 2019
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.13569
Subject(s) - medicine , meta analysis , diabetic nephropathy , confidence interval , type 2 diabetes , diabetes mellitus , microalbuminuria , ethnic group , demography , incidence (geometry) , disease , endocrinology , kidney , sociology , anthropology , physics , optics
Aims To conduct a systematic review and meta‐analysis of published observational evidence to assess the difference in the prevalence and progression of diabetic nephropathy, and the development of end‐stage renal disease (ESRD) in people from three different ethnic groups with type 2 diabetes (T2DM). Materials and methods Relevant studies were identified in a literature search of MEDLINE, EMBASE and reference lists of relevant studies published up to May 2018. We decided a priori that there were no differences in the prevalence and progression of diabetic nephropathy, and the development of ESRD in the three ethnicities with T2DM. Pooled relative risks of microalbuminuria by ethnicity were estimated by fitting three random effects meta‐analyses models. A narrative synthesis of the nephropathy progression in the studies was carried out. The review was registered in PROSPERO (CRD42018107350). Results Thirty‐two studies with data on 153 827 unique participants were eligible for inclusion in the review. The pooled prevalence ratio of microalbuminuria in South Asian compared with white European participants was 1.14 (95% confidence interval [CI] 0.99, 1.32; P = 0.065), while for African Caribbean vs South Asian participants the pooled prevalence ratio was 1.08 (95% CI 0.93, 1.24; P = 0.327). Results for renal decline were inconsistent, with preponderance towards a high rate of disease progression in South Asian compared with white participants. The estimated pooled incidence rate ratio (IRR) for ESRD was significantly higher in African Caribbean vs white European participants: 2.75 (95% CI 2.01, 3.48; P < 0.001). Conclusion The results of this review did not show a significant link between ethnicity (South Asian, white European and African Caribbean) and the prevalence of microalbuminuria; however, the IRR for ESRD in African Caribbean compared with white European participants was significantly higher. Further research is needed to explore the potential non‐albuminuric pathways of progression to ESRD.