{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T16:11:40Z","timestamp":1789056700319,"version":"build-2803163510"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","funder":[{"DOI":"10.13039\/100000009","name":"Foundation for the National Institutes of Health","doi-asserted-by":"crossref","award":["1OT2OD032581"],"award-info":[{"award-number":["1OT2OD032581"]}],"id":[{"id":"10.13039\/100000009","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2026,9]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n Knowledge of the risk of major adverse kidney events in the American Indian or Alaska Native population with diabetes is limited.<\/jats:p>\n <\/jats:list-item>\n \n Compared with the non-Hispanic White population, the American Indian or Alaska Native population was younger with poorer glycemic control.<\/jats:p>\n <\/jats:list-item>\n \n This population had a 20% higher risk of major adverse kidney events with social drivers of health and health care utilization as key predictors.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n CKD and diabetes disproportionately affect the American Indian (AI) or Alaska Native (AN) population, but understanding of major adverse kidney events (MAKE) in this population is limited.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Electronic health records from the Providence health system identified the AI or AN adult population with diabetes during 2013\u20132022. A 1-year window surrounding diabetes cohort entry was used to collect baseline data. Kaplan\u2013Meier analyses assessed MAKE (\u226540% eGFR decline, eGFR <15 ml\/min per 1.73 m\n 2<\/jats:sup>\n , dialysis or kidney transplant, and all-cause death) with propensity score matching (1:3) of AI or AN people to reference individuals (non-Hispanic White) by demographics and clinical characteristics. Cox proportional hazards modeling estimated associations between demographic, clinical, social, and health care utilization variables and MAKE.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The AI or AN population (\n N<\/jats:italic>\n =6103) was younger (mean\u00b1SD age 54\u00b115 years) with higher hemoglobin A1c (mean 7.4\u00b12.2 mg\/dl) compared with the reference population (\n N<\/jats:italic>\n =354,283; age 62\u00b114 years; hemoglobin A1c 6.9%\u00b11.8%). During a median follow-up of 4.1 (interquartile range, 2.0\u20136.4) years, the AI or AN population experienced a higher frequency of MAKE (26%,\n n<\/jats:italic>\n =1614) than the reference population (24%,\n n<\/jats:italic>\n =85,920). With propensity score matching, MAKE survival estimates were significantly lower in the AI or AN population (\n P<\/jats:italic>\n < 0.0001). In the adjusted Cox model, increased MAKE risk was observed for the AI or AN population (versus reference population, hazard ratio [HR] 1.20, 95% confidence interval [CI], 1.15 to 1.27), higher social vulnerability index (HR, 1.05; 95% CI, 1.05 to 1.05), and hospitalization (HR, 1.98; 95% CI, 1.95 to 2.01), while more primary care visits were associated with lower MAKE risk (HR, 0.78; 95% CI, 0.77 to 0.79).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The risk of MAKE was significantly increased in the AI or AN population with diabetes. Social factors and health care utilization importantly contributed to risk prediction for MAKE.<\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.0000001121","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T18:02:10Z","timestamp":1782237730000},"page":"1521-1530","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Major Adverse Kidney Events in the American Indian or Alaska Native Population with Diabetes"],"prefix":"10.2215","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0523-647X","authenticated-orcid":false,"given":"Anna","family":"Zemke","sequence":"first","affiliation":[{"name":"Nephrology Division and Kidney Research Institute, University of Washington School of Medicine, Seattle, Washington"},{"name":"Swedish Nephrology, Swedish Medical Center, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4808-5632","authenticated-orcid":false,"given":"Kiara N.","family":"Mayhand","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5437-5700","authenticated-orcid":false,"given":"Radica Z.","family":"Alicic","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Washington School of Medicine, Seattle, Washington"},{"name":"Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5852-1209","authenticated-orcid":false,"given":"Lindsey M.","family":"Kornowske","sequence":"additional","affiliation":[{"name":"Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3382-5753","authenticated-orcid":false,"given":"Cami R.","family":"Jones","sequence":"additional","affiliation":[{"name":"Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9194-4140","authenticated-orcid":false,"given":"Kenn B.","family":"Daratha","sequence":"additional","affiliation":[{"name":"Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9598-3366","authenticated-orcid":false,"given":"Christina L.","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Providence Medical Research Center, Providence Inland Northwest Health, Spokane, 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