Kidney diseases claim countless lives, with nearly 40 million US adults suffering from chronic kidney disease (CKD). 40% of people with severely reduced kidney function (not on dialysis) are not aware of having CKD. Every 24 hours, 360 people begin dialysis treatment for kidney failure.
Kidney diseases are a national health concern, and the problem is even worse for Native Americans. For example, The Pima Indians of Arizona have the highest rates of diabetes in the world, with more than half of adults diagnosed with type 2 diabetes. About 50% of Pima adults over 35 years old have type 2 diabetes. Though many strides have been made to understand the reason for this disproportionate vulnerability, it's still not enough to tackle this ongoing crisis.
Learn more about the science behind kidney disease, the increased impact on the Native American population, and nephrologist Dr. Kariappa Appachu's calls for further research and awareness to turn the tide against these illnesses.
The Causes and Impacts of Kidney Disease
In the United States, diabetes and high blood pressure are the leading causes of kidney failure, accounting for 3 out of 4 new cases. High blood sugars from diabetes can damage the small blood vessels in the kidneys, impairing their ability to filter waste efficiently. Over time, this can lead to kidney dysfunction and even kidney failure.
Diseased kidneys gradually lose their ability to function properly and can cause a dangerous buildup of waste, fluid, and electrolytes. This puts a lot of strain on the body, leading to swelling in the legs and ankles, fatigue, nausea, confusion, decreased urine output, and shortness of breath.
Even with well-controlled blood sugar levels, individuals with diabetes remain at risk for kidney damage, necessitating additional medications—often a costly array of prescriptions—alongside healthy lifestyle modifications. In cases of end-stage kidney disease, patients may require dialysis to assist with blood filtration.
The Native American Diabetes Epidemic
The Native American community faces a severe epidemic of diabetes, which significantly impacts their health and quality of life. Historically, high rates of diabetes in this population are compounded by socioeconomic factors such as poor access to nutritious food and adequate healthcare. Diabetes prevalence among Native Americans is more than double that of non-Hispanic whites, leading to a higher incidence of diabetes-related complications, including kidney disease and heart problems. Efforts to address this crisis include culturally tailored diabetes prevention and treatment programs, which emphasize community involvement and integrate traditional practices. However, the persistent challenges of healthcare access and economic barriers continue to hinder progress. The epidemic not only reflects public health failure but also underscores the urgent need for targeted interventions that address the unique needs of Native American communities.
As of 2010, more than half of the Arizona Native American population, Pima Nation, had diabetes—the highest rate in the world. The result is a sad, unfortunate reality: Native Americans are 2.5 times more likely to die from complications with diabetes than the average American.
Combatting the Crisis with Dr. Kariappa Appachu
Nephrologist Dr. Kariappa Appachu has firsthand experience with the gravity of kidney disease among Native Americans. He's been working as a physician at the Southwest Kidney Institute in Arizona for nearly a decade, fighting on the frontlines of this often-overlooked epidemic while treating veterans and Native Americans.
Dr. Appachu grew up in a small town in southern India, outside Bangalore. From a young age, his father's political career and the lack of health resources in his community taught him the importance of caring for others. So after graduating from medical school, he made his way to the US, where he completed his internal medicine residency at St. Joseph's/Creighton University, Arizona, and subsequently his nephrology fellowship at the University of Southern California/LA county.
He began working in Casa Grande, a small city about 45 minutes south of Phoenix with a population of around 100,000 people. After witnessing the surrounding Native American population's need for medical care, he decided to stay. He also served at Native American reservation clinics/dialysis units in Tuba City and Chinle, Northern Arizona, between 2014 and 2016.
Dr. Appachu explains that diabetes insidiously damages the kidneys over time, and once this damage occurs, it is irreversible, often necessitating dialysis treatment. Patients can receive dialysis at home, known as peritoneal dialysis, or at a clinic through hemodialysis. This condition leads to a frequent influx of patients at various stages of kidney disease seeking care at hospitals and clinics. "Despite the small size of the towns," he notes, "dialysis units serving Native American communities are typically at capacity due to the high prevalence of kidney issues among these populations."
He observes that diabetes and kidney disease exacerbate the existing challenges faced by Native Americans, who are already at a socioeconomic disadvantage. "These health issues significantly widen the gap in their quality of life," he remarks. Moreover, the necessity for frequent dialysis treatment, which often involves lengthy travel and extensive hours spent in clinics, further complicates their ability to improve their quality of life.
Turning the Tide with Awareness and Research
Dr. Appachu finds optimism in ongoing research focused on the genetics of the Pima Indians, which aims to uncover the reasons behind their high susceptibility to diabetes through genome-wide linkage scans and the possible potential of gene therapy as an intervention. He stresses the critical need for enhanced preventive measures against diabetes and kidney disease among these populations. Given that the Pima Indians of Arizona exhibit the highest prevalence of diabetes globally, Dr. Appachu is hopeful that increased research will illuminate the necessity for additional resources and support for Native communities. "Hopefully, we can highlight the urgent need for more research in this area and secure the vital resources our Native populations require," he notes. Dr. Appachu's story provides a real-world example of how more resources and awareness can forge a way forward through this crisis.
