Prevalence and progression of diabetic nephropathy in South Asians, White Europeans and Afro-Caribbeans with Type 2 diabetes; a systematic review and meta-analysis.

INTRODUCTION: Diabetic nephropathy remains the most common cause of renal disease in patients diagnosed with type 2 diabetes.

AIMS: We conducted 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 failure in three ethnicities with type 2 diabetes.

METHODS: Relevant studies were identified in a literature search of MEDLINE, EMBASE, and reference lists of relevant studies to May 2018. We decided a priori that there were no differences in the prevalence and progression of diabetic nephropathy, and the development of end-stage renal failure in the three ethnicities with type 2 diabetes. 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 done. The review was registered on PROSPERO (registration number CRD42018107350).

RESULTS: Thirty-two studies with data on 153,827 unique participants were eligible. The pooled prevalence ratio of microalbuminuria in South Asian compared to White Europeans was 1.14 (95% CI: 0.99, 1.32 p=0.065). For African Caribbeans vs South Asians the pooled prevalence ration was 1.08 (95% CI: 0.93, 1.24), p=0.327. Results surrounding renal decline were inconsistent with preponderance towards a high rate of disease progression in South Asians compared to White Caucasians. The estimated pooled incident rate ratio for end stage renal disease was significantly higher in African Caribbeans vs White Europeans 2.75 (95% CI: 2.01, 3.48 p<0.001) CONCLUSION: This review did not find a significant link between ethnicity (South Asians, White Europeans and Afro-Caribbeans) and the prevalence of microalbuminuria. However, the incident rate ratio of end stage renal disease in African Caribbeans compared to White Europeans was significantly higher. Further research is needed to explore the potential non-albuminuric pathways of progression to end stage renal failure. This article is protected by copyright. All rights reserved.