Cruz I A, Hosten A O
J Natl Med Assoc. 1991 Apr;83(4):309-12.
It is projected that the proportion of black Americans, American Indians, Asian Americans, and Hispanic Americans entering the ESRD program will continue to increase. Despite the increase in the average age of the ESRD population, the minorities entering the ESRD program are much younger. The major risk factors of ESRD--hypertension, diabetes, and glomerulonephritis--are affecting these minorities at a higher rate and in varying combinations. High prevalence and severity of hypertension followed by diabetes mellitus are the major risk factors in blacks, especially black women. Heroin and HIV nephropathies, tied to the epidemic of illicit drug abuse, have a major impact on young black men. The high prevalence of diabetes and the epidemic of glomerulonephritis in certain tribes are the major risk factors in American Indians. Hypertension and diabetes are the risk factors for the rapidly increasing Asian American population, especially for the elderly segment of this population. Diabetes predominates as the risk factor for the rapidly growing Hispanic American population, a group that needs to be identified separately within the ESRD program. Diabetes and hypertension are treatable, and adequate control can prevent progression of renal failure. However, with minority groups, it is difficult to fully implement the measures necessary to achieve this control. Outreach programs are necessary not only to provide medical treatment but to include instruction in socioeconomic and educational strategies. Programs that will seek out these patients and treat them should also educate them about their diet, about the detrimental effects of alcohol and smoking, and about the danger of substance abuse. Ultimately, these programs may be much cheaper than supporting a rapidly increasing ESRD program.
预计进入终末期肾病（ESRD）项目的非裔美国人、美国印第安人、亚裔美国人和西班牙裔美国人的比例将持续上升。尽管ESRD患者群体的平均年龄有所增加，但进入ESRD项目的少数族裔患者年龄要小得多。ESRD的主要危险因素——高血压、糖尿病和肾小球肾炎——正以更高的发生率和不同的组合方式影响着这些少数族裔。高血压的高患病率和严重程度，其次是糖尿病，是黑人尤其是黑人女性的主要危险因素。与非法药物滥用流行相关的海洛因肾病和HIV肾病，对年轻黑人男性有重大影响。某些部落中糖尿病的高患病率和肾小球肾炎的流行，是美国印第安人的主要危险因素。高血压和糖尿病是亚裔美国人数量迅速增加群体的危险因素，尤其是该群体中的老年人。糖尿病是西班牙裔美国人数量迅速增长群体的主要危险因素，这一群体在ESRD项目中需要单独识别。糖尿病和高血压是可以治疗的，充分控制可以预防肾衰竭的进展。然而，对于少数族裔群体来说，很难全面实施实现这种控制所需的措施。外展项目不仅有必要提供医疗治疗，还应包括社会经济和教育策略方面的指导。那些寻找这些患者并为其治疗的项目，还应就他们的饮食、酒精和吸烟的有害影响以及药物滥用的危险对他们进行教育。最终，这些项目可能比支持迅速扩大的ESRD项目成本低得多。
