Zuni Indians Research Articles

51-OR: Anxiety and Changes in Health Care Access and Health Behaviors during COVID-in Southwest Tribal Community Patients with Prediabetes and Diabetes

Objective: The impact of COVID-has been devastating to many, but particularly to rural populations of American Indians from Zuni Pueblo who suffer multiple vulnerabilities which places them at greater risk for infection and death. Very little is known about the change in health behaviors owing to the COVID pandemic among a chronically ill (diabetes) rural Zuni population. We evaluated the anxiety and stress about COVID-contributing to poorer mental health outcomes in Zuni Indians with PreDM and T2DM. Methods: We conducted a survey among individuals with hyperglycemia in Zuni Indians. There were 300 participants who responded to the survey, of which 193 participants also had baseline clinical health data. Results: Those with T2DM experienced higher pandemic-related anxiety than those with pre-DM (+3.9 vs. -0.6, p=0.0616, on a scale -30 to +30) . Those with T2DM were more likely to report decreased physical activity (54% vs. 44%) , decreased frequency in lab testing (21% vs. 10%) , and increased virtual contact with providers (61% vs. 48%) during the pandemic. We conducted regression analyses to describe correlations of anxiety and weight change with the changes in health behaviors. We found that participants with improved diet and exercise during the pandemic were less likely to experience weight gain (OR= 0.78, p=0.0017 and OR=0.75, p=0.0094, respectively) . We also found that those who reported worsening health care during the pandemic experienced increased anxiety (+4.9, p=0.0049) . Conclusion: Our study provides important insights into (unintended) consequential effect of COVID crisis in rural Zuni which will contribute to a better understanding of how to preserve mental health and maintain health behaviors in patients with diabetes during the pandemics. Disclosure J.Reno: None. Y.Zhu: None. V.Shah: n/a. Funding National Institute of General Medical Sciences of the National Institutes of Health (P20GM103451)

Diabetes status modifies the efficacy of home-based kidney care for Zuni Indians in a randomized controlled trial.

Home-Based Kidney Care (HBKC) is a pragmatic treatment approach that addresses patient preferences and cultural barriers to healthcare. We previously reported the results of a clinical trial of HBKC vs. usual care in a cohort of Zuni Indians in New Mexico. This study investigated the potential for differential efficacy of HBKC vs. usual care according to type 2 diabetes (T2DM) status. We analyzed the data from all individuals who participated in a randomized clinical trial that compared HBKC to usual care among patients with CKD, and assessed whether the effect of the HBKC intervention affected the subset of patients with T2DM differently than those individuals without T2DM. We used linear regression models to estimate the effect of HBKC on improvement in Patient Activation Measure (PAM) total scores within the groups of participants defined by T2DM status, and to compare the effects between these two groups. We used generalized estimating equations (GEE) to account for household clustering. The original study enrolled 63 participants into the HBKC group, and 62 into the usual care. Ninety-eight of these individuals completed the 12-month intervention, 50 in the HBKC group and 48 in the usual care group. The present study compared the intervention effect in the 56 participants with T2DM (24 participants in the HBKC group and 32 in usual care) to the intervention effect in the 42 participants without T2DM (26 participants in the HBKC group and 16 in usual care). Those with T2DM who received the HBKC intervention experienced an average increase in PAM total scores of 16.0 points (95% Confidence Interval: 8.8-23.1) more than those with T2DM who were in the usual care group. For those without T2DM, the intervention had essentially no effect, with those who received the HBKC intervention having an average PAM total scores that was 1.4 points (95% C.I.: -12.4 to 9.6) lower than those who received usual care. There was a significantly different HBKC treatment effect by T2DM status (p = 0.02). This secondary analysis suggests that the effectiveness of this HBKC intervention on increasing patient activation is most notable among those CKD patients who also have T2DM.

1214-P: Assessing the Efficacy of Home-Based Kidney Care on Patient Activation Measure (PAM) among Patients with Diabetes

Objective: Home-Based Kidney Care (HBKC) is a pragmatic treatment approach that addresses patient preferences and cultural barriers to healthcare. We previously reported the results of a clinical trial of HBKC vs. usual care in a cohort of Zuni Indians in New Mexico. This study investigated the potential for differential efficacy of HBKC vs. usual care according to type 2 diabetes status of the Zuni Indians who had participated in the trial. Methods: Participants identified as having evidence of chronic kidney disease were enrolled into the original trial, and were randomized into either HBKC or usual care. Participants were subsequently categorized according to type 2 diabetes status. Linear regression models were used to test for the presence of a differential treatment effect by diabetes status and to estimate treatment effects within those with and without diabetes. Results: The original study enrolled 63 participants into the HBKC group, and 62 into usual care. Twenty-four (38.1%) participants in the HBKC group and 32 (51.6%) in usual care had diabetes. The test for interaction between diabetes status and treatment arm suggested a significant differential treatment effect by diabetes status (p=0.022). The treatment effect among those with diabetes showed that PAM total scores increased by 16.0 points (95% Confidence Interval [CI]: 8.8 to 23.1) more in the HBKC group than in the usual care group, while changes in PAM total scores were similar in both treatment groups among those without diabetes (treatment effect [95% CI] = -1.4 [-12.4 to 9.6]). Conclusions: We have previously shown that HBKC is effective in increasing the engagement of Zuni Indians with CKD in their healthcare. This secondary analysis suggests that the effectiveness of this intervention on increasing patient activation is most notable among those CKD patients who also have diabetes. Disclosure V. Shah: None. V.S. Pankratz: None. D.M. Ghahate: None. J. Bobelu: None. R. Nelson: None. Funding Patient-Centered Outcomes Research Institute

Home-Based Kidney Care, Patient Activation, and Risk Factors for CKD Progression in Zuni Indians: A Randomized, Controlled Clinical Trial.

The burden of CKD is greater in ethnic and racial minorities and persons living in rural communities, where access to care is limited. A 12-month clinical trial was performed in 98 rural adult Zuni Indians with CKD to examine the efficacy of a home-based kidney care program. Participants were randomized by household to receive usual care or home-based care. After initial lifestyle coaching, the intervention group received frequent additional reinforcement by community health representatives about adherence to medicines, diet and exercise, self-monitoring, and coping strategies for living with stress. The primary outcome was change in patient activation score, which assesses a participant's knowledge, skill, and confidence in managing his/her own health and health care. Of 125 randomized individuals (63 intervention and 62 usual care), 98 (78%; 50 intervention and 48 usual care) completed the 12-month study. The average patient activation score after 12 months was 8.7 (95% confidence interval, 1.9 to 15.5) points higher in the intervention group than in the usual care group after adjusting for baseline score using linear models with generalized estimating equations. Participants randomized to the intervention had 4.8 (95% confidence interval, 1.4 to 16.7) times the odds of having a final activation level of at least three ("taking action") than those in the usual care group. Body mass index declined by 1.1 kg/m2 (P=0.01), hemoglobin A1c declined by 0.7% (P=0.01), high-sensitivity C-reactive protein declined by 3.3-fold (P<0.001), and the Short-Form 12 Health Survey mental score increased by five points (P=0.002) in the intervention group relative to usual care. A home-based intervention improves participants' activation in their own health and health care, and it may reduce risk factors for CKD in a rural disadvantaged population.

Health Disparity in Diabetes Care—Impact of Community Health Representative–Led Patient Activation and Engagement

Objective: To compare the impact of home-based care and education delivered by community health representatives (CHRs) as part of a clinical care team vs. usual clinic-based care on measures of patient activation and risk factors for diabetes in adult Zuni Indians. Methods: We conducted a pilot randomized controlled trial of a home-based intervention vs. usual clinic care provided by the local Zuni Indian Health Service (IHS). The study’s primary outcome was patient activation, assessed by the Patient Activation Measure (PAM). We screened 315 Zuni adults and enrolled and randomized 125 Zuni adults into the study. We used linear and logistic regression with generalized estimating equations to compare changes in the outcomes of interest over time between the two study groups. Results: Compared to those receiving usual care at IHS, Zuni adults in the intervention group experienced significantly greater improvement in the patient activation measure, quality of life, and in several clinical measures of risk factors for diabetes at 12 months. Participants in the intervention increased their PAM total scores, on average, by 8.6 points more than participants randomized to usual care (p=0.023). BMI in the intervention group decreased by 1.kg/m2 more than was observed in the control group (p=0.007). Hemoglobin A1C levels in the intervention group decreased by 8% more than in the control group (p=0.022). The hs-CRP levels in the intervention group decreased by 62% more than in the control group (p&amp;lt;0.001). Discussion: Delivering culturally appropriate home-based care and education by CHRs is a promising approach for improving disease-specific knowledge, confidence, and self-management skills among rural minority populations at high risk for diabetes who experience barriers to accessing health care. Disclosure V. Shah: None. V.S. Pankratz: None. D.M. Ghahate: None. J. Bobelu: None. R. Nelson: None.

A Home-Based Educational Intervention Improves Patient Activation Measures and Diabetes Health Indicators among Zuni Indians.

IntroductionOne in three people will be diagnosed with diabetes by 2050, and the proportion will likely be higher among Native Americans. Diabetes control is currently suboptimal in underserved populations despite a plethora of new therapies. Patient empowerment is a key determinant of diabetes control, but such empowerment can be difficult to achieve due to resource limitation and cultural, language and health literacy barriers. We describe a home-based educational intervention using Community Health Representatives (CHRs), leading to improvement in Patient Activation Measures scores and clinical indicators of diabetes control.MethodsSixty participants with type 2 diabetes (T2D) completed a baseline evaluation including physical exam, Point of Care (POC) testing, and the Patient Activation Measure (PAM) survey. Participants then underwent a one hour group didactic session led by Community Health Representatives (CHRs) who subsequently carried out monthly home-based educational interventions to encourage healthy lifestyles, including diet, exercise, and alcohol and cigarette avoidance until follow up at 6 months, when clinical phenotyping and the PAM survey were repeated.ResultsPAM scores were increased by at least one level in 35 (58%) participants, while 24 participants who started at higher baseline score did not change. Six months after intervention, mean levels of A1C decreased by 0.7 ± 1.2%; fasting blood glucose decreased by 24.0 ± 38.0 mg/dl; BMI decreased by 1.5 ± 2.1 kg/m2; total cholesterol decreased by 12.0± 28.0 mg/dl; and triglycerides decreased by 52.0 ± 71.0 mg/dl. All of these changes were statistically significant (p<0.05).ConclusionThis six month, CHR led and community-oriented educational intervention helps inform standards of practice for the management of diabetes, engages diabetic populations in their own care, and reduces health disparities for the underserved population of Zuni Indians.Trial RegistrationClinicalTrials.gov NCT02339311

Genetics of kidney disease and related cardiometabolic phenotypes in Zuni Indians: the Zuni Kidney Project

The objective of this study is to identify genetic factors associated with chronic kidney disease (CKD) and related cardiometabolic phenotypes among participants of the Genetics of Kidney Disease in Zuni Indians study. The study was conducted as a community-based participatory research project in the Zuni Indians, a small endogamous tribe in rural New Mexico. We recruited 998 members from 28 extended multigenerational families, ascertained through probands with CKD who had at least one sibling with CKD. We used the Illumina Infinium Human1M-Duo version 3.0 BeadChips to type 1.1 million single nucleotide polymorphisms (SNPs). Prevalence estimates for CKD, hyperuricemia, diabetes, and hypertension were 24%, 30%, 17% and 34%, respectively. We found a significant (p < 1.58 × 10-7) association for a SNP in a novel gene for serum creatinine (PTPLAD2). We replicated significant associations for genes with serum uric acid (SLC2A9), triglyceride levels (APOA1, BUD13, ZNF259), and total cholesterol (PVRL2). We found novel suggestive associations (p < 1.58 × 10-6) for SNPs in genes with systolic (OLFML2B), and diastolic blood pressure (NFIA). We identified a series of genes associated with CKD and related cardiometabolic phenotypes among Zuni Indians, a population with a high prevalence of kidney disease. Illuminating genetic variations that modulate the risk for these disorders may ultimately provide a basis for novel preventive strategies and therapeutic interventions.

Genetics of kidney disease and related cardiometabolic phenotypes in Zuni Indians: the Zuni Kidney Project

Genetics of kidney disease and related cardiometabolic phenotypes in Zuni Indians: the Zuni Kidney Project

Assessing knowledge and attitudes of diabetes in Zuni Indians using a culture-centered approach.

IntroductionThe Zuni Pueblo, in collaboration with the University of New Mexico, have formed the Zuni Health Initiative (ZHI) engaged in community-based participatory research to plan and implement educational interventions to reduce health disparities. We conducted the first phase of ZHI study and identified barriers to healthcare. We concluded that the burden presented by these barriers ultimately translates into a lack of patient activation and engagement in their health care including for diabetes, effectively hindering adoption of healthy behaviors.MethodsCommunity health representatives (CHRs) led 10 one-hour focus group sessions to elicit information on diabetes knowledge and self-management strategies at which a total of 84 people participated. Audiotapes were translated and transcribed by bilingual ZHI staff. We reduced the text to thematic categories, constructed a coding dictionary and inserted the text into NVivo 9 program.ResultsThe focus groups revealed that despite extensive personal or family experiences with diabetes or complications, participants identified knowledge gaps in the disease progression and disease management. However, we gained insight into how many Zunis conceptualize the etiology of diabetes, risk factors associated with diabetes, sources of knowledge and self-management practices.ConclusionWe concluded that many of the Zuni diabetics experience significant impacts on their life when they were diagnosed with diabetes and suffered the plight of stigmatization. We further concluded that developing Zuni culture specific diabetes care should focus on family involvement with continued education.

On the Frontier of Photography: Carl Lumholtz and the Kodak Snapshot Camera

On the Frontier of Photography: Carl Lumholtz and the Kodak Snapshot Camera Phyllis La Farge (bio) In September 1890 the Norwegian naturalist and ethnographer Carl Lumholtz crossed the border into Mexico from Bisbee, Arizona. He was embarking on an expedition that in time would be the first of four, leading from the states of Sonora and Chihuahua as far south as Michoacán. Underlying his commitment to this venture was his experience as an explorer in Queensland, Australia. There, between 1880 and 1884, sponsored by the Zoological Museum in Christiana (as Oslo was then called), he collected plant and animal specimens. While spending the better part of a year in the remote Herbert River region, he came to appreciate the aboriginal people of the area, valuing their help and their knowledge of local flora and fauna. Having gone to Australia as a botanist and zoologist, he returned to Norway, a would-be ethnographer. Several years passed, however, before he decided on a way to pursue this new professional direction. As he subsequently wrote in Unknown Mexico, his account of his Mexican travels: I first conceived the idea of an expedition to Mexico while on a visit to London in 1887. I had, of course, as we all have, heard of the wonderful cliff-dwellings in the Southwest of the United States, of entire villages built in caverns on steep mountain-sides, accessible in many cases only with the aid of ladders. Within the territory of the United States there were, to be sure, no survivors of the race that had once inhabited those dwellings. But the Spaniards, when first discovering and conquering that district, are said to have come [End Page 473] upon dwellings then still occupied. Might there not, possibly, be descendants of the people yet in existence in the northwestern part of Mexico hitherto so little explored?1 It is not clear what individuals, lectures, or readings may have inspired him during his London visit but his decision can be understood in the context of the increasing interest at the time in the anthropology and archaeology of the American Southwest. In 1879, in an early effort to promote serious study of Native Americans, John Wesley Powell, the geologist and explorer who became the founding director of the Bureau of Ethnology—later the American Bureau of Ethnology—sent the anthropologists John Stevenson; his wife, Matilda Coxe Stevenson; and Frank Hamilton Cushing to study the Zuni Indians. The same year saw another milestone in the growing attention to the past and present of the area, the founding of the Archaeological Institute of America (AIA). The first president of the institute, the art historian Charles Eliot Norton (and others), favored a focus on the archaeology of ancient Greece and Egypt—wasn’t the investigation of ancient “high cultures” far more important than excavating the paltry remains of peoples whose descendants were still only a few steps above savagery? But the historian Francis Parkman (who had lived for a period with the Sioux Indians) and Frederick Ward Putnam, director of Harvard University’s Peabody Museum of American Archaeology and Ethnology, were successful in pressing to make American archaeology one of the goals of the institute. At the suggestion of the pioneering anthropologist Lewis Henry Morgan, this policy led to the choice of the scholar-archaeologist Adolph Bandelier to explore and document archaeological sites in the Southwest. As early as February 1880, however, even before the AIA had made a firm commitment to sponsoring him in the Southwest, Bandelier had already conceived of extending his work into Mexico, thus prefiguring Lumholtz’s plan of ten years later.2 It’s reasonable to surmise that these and other developments3 were known to Lumholtz. They may well have inspired his decision and led him to meet with Bandelier and to visit the Zuni before his entry into Mexico in 1890. With his wish to find in Mexico the descendants of the builders of cliff dwellings north of the border Lumholtz hoped to establish a lost link not only between past and present but—perhaps less explicitly—what had become politically separate worlds, the North American Southwest and the northwest of Mexico. He did not...

Identifying barriers to healthcare to reduce health disparity in Zuni Indians using focus group conducted by community health workers.

The Zuni Pueblo is home to an economically disadvantaged population, which faces a public health challenge from the interrelated epidemics of obesity, diabetes and kidney disease. Efforts to decrease the impact of these epidemics have been complicated by historical, economic and cultural barriers, which may limit healthcare utilization. The NIH supported Zuni Health Initiative (ZHI) conducted a study to identify barriers to healthcare in the Zuni Pueblo. Community health representatives (CHRs) led 14 one-hour focus group sessions at which a total of 112 people participated posed unique questions that took into account the Zuni culture to elicit information on perceived barriers to healthcare. Audiotapes were translated and transcribed by bilingual ZHI staff. We reduced the text to thematic categories, constructed a coding dictionary and inserted the text into NVivo 9 program. We identified nine themes emerged regarding the barriers experienced in receiving healthcare and adhering to medical advice. These included distance; transportation; embarrassment; relating to healthcare professionals; navigating the medical system; awareness of available resources; waiting times; adhering to medication; and incentives in health promotion. In conclusion the implementation of culturally appropriate community-based health promotion programs and preventive screening techniques will improve access to healthcare and diminish health disparities.

Type 2 Diabetes in Aboriginal Peoples

Type 2 Diabetes in Aboriginal Peoples

Heritability of serum sodium concentration: evidence for sex- and ethnic-specific effects

Serum sodium concentration is the clinical index of systemic water balance. Although disordered water balance is common and morbid, little is known about genetic effects on serum sodium concentration at the population level. Prior studies addressed only participants of European descent and either failed to demonstrate significant heritability or showed only modest effect. We investigated heritability of serum sodium concentration in large cohorts reflecting a range of races/ethnicities, including the Framingham Heart Study (FHS, non-Hispanic Caucasian), the Heredity and Phenotype Intervention Heart Study (HAPI, Amish Caucasian), the Jackson Heart Study (JHS, African American), the Strong Heart Family Study (SHFS, American Indian), and the Genetics of Kidney Disease in Zuni Indians Study (GKDZI, American Indian). Serum sodium was transformed for the osmotic effect of glucose, and participants with markedly elevated glucose or reduced estimated glomerular filtration rate (eGFR) were excluded. Using a standard variance components method, incorporating covariates of age, glucose, and eGFR, we found heritability to be high in African American and American Indian populations and much more modest in non-Hispanic Caucasian populations. Estimates among females increased after stratification on sex and were suggestive among female participants in FHS (0.18 ± 0.12, P = 0.057) and male participants in JHS (0.24 ± 0.16, P = 0.067) and statistically significant among female participants in JHS (0.44 ± 0.09, P = 1 × 10 ⁻⁷), SHFS (0.59 ± 0.05, P = 9.4 × 10⁻⁴⁶), and GKDZI (0.46 ± 0.15, P = 1.7 × 10⁻⁴), and male participants in HAPI (0.18 ± 0.12, P = 0.03) and SHFS (0.67 ± 0.07, P = 5.4 × 10⁻²⁶). Exclusion of diuretic users increased heritability among females and was significant in all cohorts where data were available. In aggregate, these data strongly support the heritability of systemic water balance and underscore sex and ethnicity-specific effects.

Heritability of Measures of Kidney Disease Among Zuni Indians: The Zuni Kidney Project

The long-term goal of the GKDZI (Genetics of Kidney Disease in Zuni Indians) Study is to identify genes, environmental factors, and genetic-environmental interactions that modulate susceptibility to renal disease and intermediate phenotypes. A community-based participatory research approach was used to recruit family members of individuals with kidney disease. The study was conducted in the Zuni Indians, a small endogamous tribe located in rural New Mexico. We recruited members of extended families, ascertained through a proband with kidney disease and at least 1 sibling with kidney disease. 821 participants were recruited, comprising 7,702 relative pairs. PREDICTOR OUTCOMES & MEASUREMENTS: Urine albumin-creatinine ratio (UACR) and hematuria were determined in 3 urine samples and expressed as a true ratio. Glomerular filtration rate (GFR) was estimated using the Modification of Diet in Renal Disease (MDRD) Study equation modified for American Indians. Probands were considered to have kidney disease if UACR was >or=0.2 in 2 or more of 3 spot urine samples or estimated GFR was decreased according to the CRIC (Chronic Renal Insufficiency Cohort) Study criteria. Kidney disease was identified in 192 participants (23.4%). There were significant heritabilities for estimated GFR, UACR, serum creatinine, serum urea nitrogen, and uric acid and a variety of phenotypes related to obesity, diabetes, and cardiovascular disease. There were significant genetic correlations of some kidney-related phenotypes with these other phenotypes. Limitations include absence of renal biopsy, possible misclassification bias, lack of direct GFR measurements, and failure to include all possible environmental interactions. Many phenotypes related to kidney disease showed significant heritabilities in Zuni Indians, and there were significant genetic correlations with phenotypes related to obesity, diabetes, and cardiovascular disease. The study design serves as a paradigm for the conduct of research in relatively isolated, endogamous, underserved populations.

Distribution of glyoxalase I polymorphism among Zuni Indians: the Zuni Kidney Project

Zuni Indians are experiencing simultaneous epidemics of type 2 diabetes mellitus (T2DM) and renal disease [Scavini, M., Stidley, C. A., Shah, V. O., Narva, A. S., Tentori, F., Kessler, D. S., et al. (2003). Prevalence of diabetes is higher among female than male Zuni Indians: Diabetes among Zuni Indians. Diabetes Care, 26 (1), 55–60; Shah, V. O., Scavini, M., Stidley, C., Tentori, F., Welty, T., Maccluer, J. W., et al. (2003). Epidemic of diabetic and nondiabetic renal disease among the Zuni Indians: The Zuni Kidney Project. Journal of the American Society of Nephrology, 14, 1320–1329]. Methylglyoxal (MG), a highly reactive, cytotoxic, cross-linking endogenous aldehyde involved in the modification of biologic macromolecules, is elevated among patients with T2DM. Glyoxalase I (Glo1) is the initial enzyme involved in the detoxification of MG. Glo1 is a dimeric enzyme with three isoforms Glo1-1, Glo2-1, and Glo2-2, resulting from a point mutation (A→C) at position 332 of cDNA. The present study was conducted to explore the hypothesis that specific polymorphisms of the Glo1 gene are associated with diabetes and/or albuminuria in Zuni Indians. We studied four groups of Zuni Indians stratified by diabetes status and albuminuria, as assessed by the urinary albumin:creatinine ratio (UACR): Group I—normal controls; Group II—T2DM and UACR<0.03; Group III—T2DM and UACR≥0.03; and Group IV—nondiabetic participants with UACR≥0.03. Genomic DNA was used as template for polymerase chain reaction amplification of the Glo1 gene. Products were digested to yield 110-bp bands (homozygous, CC); 54- and 45-bp bands (homozygous, AA); or all three bands (heterozygous CA). Data on age, gender, UACR, serum creatinine, hemoglobin A1 c, serum glucose, systolic and diastolic blood pressures, and the duration of T2DM among participants in Groups II and III were analyzed using analysis of variance. A generalized linear model logistic regression analysis was used to assess the relationships between specific Glo1 polymorphisms to T2DM and UACR. All three Glo1 genotypes were present among Zuni Indians. There were no significant differences in the distributions of Glo1 genotypes among the study groups (chi-square test, P=.5590). The prevalence of Glo1 A allele was higher among diabetic participants (Groups II and III combined) than among nondiabetic participants (Groups I and IV combined) (chi-square test, P=.0233). There was an association (odds ratio=2.9; 95% confidence interval=1.3–7.2) between the Glo1 A allele and T2DM.

The Burden of Chronic Kidney Disease among the Zuni Indians

The Zuni Indians of New Mexico are experiencing an epidemic of chronic kidney disease (CKD). The Zuni Pueblo created the Zuni Kidney Project (ZKP) to decrease the burden of CKD in the community. The aim of this study was to estimate the prevalence of CKD among Zuni Indians using National Kidney Foundation Kidney Disease Outcomes Quality Initiative criteria. The ZKP conducted a population-based, cross-sectional survey to estimate the prevalence of CKD and related risk factors among Zuni Indians aged > or =20 yr (n = 1113). GFR was estimated using equations based on serum creatinine, and urine albumin:creatinine ratio was calculated in a single spot urine sample. ESRD counts were obtained from health care providers. The age- and sex-adjusted prevalence of CKD among the Zuni Indians was >2.5-fold higher than that among the US composite population. The estimated prevalence of CKD stages 1 and 2 combined was three- to four-fold higher than that of CKD stages 3 and 4 combined. This ratio was significantly higher than that in the US composite population (1.4-fold). The prevalence of CKD stage 5 was eight-fold higher among the Zuni Indians than among the composite US population. The Zuni Indians have an expanded pool of CKD that contributes to the high burden of ESRD. The high prevalence of CKD stages 1 and 2 provides a unique opportunity to develop innovative treatment programs to reduce the burden of CKD in Zuni Pueblo.

Kidney disease among the Zuni Indians: The Zuni Kidney Project

There is an epidemic of kidney disease among the Zuni Indians. In collaboration with health care providers and research institutions, the Zuni Pueblo established the Zuni Kidney Project to reduce the burden of kidney disease. The Zuni Kidney Project conducted a population-based, cross-sectional survey to estimate the prevalence of albuminuria, hematuria, and related risk factors. Neighborhood household clusters served as the sampling frame. Participants completed a questionnaire, donated blood and urine samples, and had blood pressure, height, and weight measured. This survey provided the foundation for ongoing studies to identify genetic and environmental risk factors for disease susceptibility and progression. Age and gender distributions among survey participants were similar to those in the eligible Zuni population. Prevalence of incipient albuminuria (IA) (0.03< or = urine albumin:creatinine ratio, UACR <0.3) and overt albuminuria (OA) (UACR < 0.3) were higher among diabetics [IA 34.3% (28.3, 40.4%); OA 18.6% (13.7, 23.6%)] than nondiabetics [IA 11.1% (9.3, 12.8%); OA 1.7% (1.0, 2.5%)]. Nondiabetics comprised 58.6% (52.2, 65.0%) and 30.9% (19.9, 41.9%) of participants with IA and OA, respectively. The prevalence of hematuria was higher among diabetics [> or = trace 47.0% (40.7, 53.4); > or =50 red blood cell/microL 25.8% (20.3, 31.4%)] than nondiabetics [> or = trace 31.1% (28.5, 33.7%); > or =50 red blood cell/microL 16.6% (14.5, 18.7%)]. Hypertension was associated with albuminuria among diabetic and nondiabetic participants. Hypercholesterolemia was associated with albuminuria among nondiabetic participants. Diabetes and alcohol use were associated with hematuria. The high prevalences of albuminuria among nondiabetics and of hematuria among diabetics and nondiabetics are consistent with high rates of nondiabetic kidney disease among Zuni Indians with and without diabetes.

Functional Disability and Associated Factors Among Older Zuni Indians

Few studies have focused on American Indian elderly and functional disability, and none have explored potential moderating or mediating factors that may lend themselves to subsequent intervention. The purpose of this study was to describe the extent of functional disability in elders and to determine which factors were associated with a higher number of Activities of Daily Living (ADL) limitations. The study was a secondary data analysis of an existing survey of American Indian elders in one southwest tribe. Functional disability was defined as limitations in ADLs and was measured by the percent of respondents reporting specific limitations and by the mean total ADL limitations. Multiple linear regression analyses were used to determine the demographic, socioeconomic and health factors associated with ADL limitations. In the 90 elders surveyed, 40 percent of respondents reported a limitation with bathing, 31 percent with walking, and 22 percent with dressing. Only 6 percent of the elders surveyed, however, reported their health status as "poor" on a 5-point scale. Factors associated with more ADL limitations included poorer health status, less frequent exercise, and more elder care services used. Rates of functional disability in this tribe were higher than those found in the U.S. for all races. Further studies are needed to understand functional disability in American Indian elders and their need for long-term care services.

Prevalence of hematuria among zuni indians with and without diabetes: the zuni kidney project

Background:There is an epidemic of kidney disease among the Zuni Indians. In contrast to other American Indian tribes, the epidemic among the Zuni Indians is attributable to diabetic and nondiabetic renal disease. Methods:The Zuni Kidney Project, established to reduce the burden of renal disease, conducted a population-based cross-sectional survey of Zuni Indians aged 5 years or older to precisely estimate the prevalence of hematuria. The survey used neighborhood household clusters as the sampling frame to maximize ascertainment and minimize bias. During the survey, we administered a questionnaire; collected blood and urine samples; and measured blood pressure, height, and weight. Results:Age and sex distributions in our sample (n = 1,469) were similar to those of the eligible Zuni population (n = 9,228). Prevalences of hematuria, defined as dipstick of trace or greater and 50 red blood cells/μL or greater, age- and sex-adjusted to the Zuni population aged 5 years or older, were 33.2% (95% confidence interval [CI], 30.7 to 35.6) and 17.8% (95% CI, 15.8 to 19.8), respectively. Hematuria of trace or greater was more common among females (40.6%; 95% CI, 37.0 to 44.1) than males (25.1%; 95% CI, 21.8 to 28.4). Hematuria of trace or greater was common among Zuni Indians without diabetes (females, 39.7%; 95% CI, 35.7 to 43.8; males, 22.7%; 95% CI, 19.4 to 26.1) and with diabetes (females, 47.5%; 95% CI, 39.8 to 55.2; males, 45.8%; 95% CI, 34.3 to 57.3). Diabetes and alcohol use for greater than 10 years were associated with hematuria among males, but not females. Conclusion:The prevalence of hematuria is high among Zuni Indians with and without diabetes. These findings are consistent with the hypothesis that nondiabetic kidney disease is common among Zuni Indians with and without diabetes.

Epidemic of diabetic and nondiabetic renal disease among the Zuni Indians: the Zuni Kidney Project.

There is an epidemic of renal disease among the Zuni Indians. The prevalence of end-stage renal disease among the Zuni Indians is 18.4-fold and 7.4-fold higher than among European Americans and American Indians/Alaskan Natives, respectively. In contrast to other American Indian tribes, nondiabetic renal disease accounts for a significant percent of the renal disease burden among the Zuni Indians. To explore this hypothesis, a community epidemiologic study of the Zuni Pueblo was conducted. A questionnaire was administered, blood and urine samples were collected, and BP, height, and weight were measured. Neighborhood household clusters were used as the sampling frame to maximize ascertainment and minimize bias. Age and gender distributions in the sample (n = 1483) were similar to those of the eligible Zuni population (n = 9228). The prevalence, age-adjusted and gender-adjusted to the Zuni population, of incipient (0.03 < or = UACR < 0.3) albuminuria (IA) (15.0% [95% confidence interval, 13.1 to 16.9%]), and overt (UACR > or = 0.3) albuminuria (OA) (4.7% [3.6 to 5.8%]) was high. The prevalence estimates for IA and OA were higher among diabetic participants (IA: 33.6% [27.6 to 39.7%]; OA: 18.7% [13.7 to 23.7%]) than nondiabetic participants (IA: 10.8% [9.0 to 12.6%]; OA: 1.8% [1.0 to 2.5%]). However, there were more nondiabetic participants; therefore, they comprised 58.0% [51.4 to 64.6%] and 30.9% [20.0 to 41.7%] of participants with IA and OA, respectively. In contrast to most other American Indian tribes, nondiabetic renal disease contributes significantly to the overall burden of renal disease among the Zuni Indians.