NEPHROLOGY 2005; 10, 291–295 doi:10.1111/j.1440-1797.2005.00415.x © 2005 Asian Pacific Society of Nephrology. Blackwell Science, LtdOxford, UKNEPNephrology1320-53582005 Asian Pacific Society of Nephrology103291295Original Article Diabetic end-stage renal disease in MicronesiaSM Abidi et al. Correspondence: Dr Robert G Nelson, National Institutes of Health, 1550 East Indian School Road, Phoenix, AZ 85014-4972, USA. Email: rnelson@phx.niddk.nih.gov Accepted for publication 27 February 2005. Original Article Diabetic end-stage renal disease in the indigenous population of the Commonwealth of the Northern Mariana Islands SYED M ABIDI, 1 HILMER O NEGRETE, 1 IMRAN ZAHID, 1 PETER H BENNETT 2 and ROBERT G NELSON 2 1 Department of Public Health, Commonwealth Health Center, Commonwealth of the Northern Mariana Islands and 2 Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, USA SUMMARY: The number of cases of treated end-stage renal disease (ESRD) attributable to type 2 diabetes and survival after the onset of renal replacement therapy was examined in the Com- monwealth of the Northern Mariana Islands (CNMI). All Chamorros and Carolinians to receive renal replacement therapy for ESRD between January 1982 and December 2002 were identified. Changes in survival over time were examined by dividing the study into three equal periods. Of 180 new cases of ESRD, 137 (76%; 101 Chamorros, 36 Carolinians) were attributed to diabetes. Ninety-nine subjects, 80% of whom had diabetic ESRD, began renal replacement therapy in the last 7 years of the study compared with 81 (72% with diabetic ESRD) in the previous 14 years. All 137 of the diabetic subjects received haemodialysis. During the 21-year study period, 79 of the diabetic subjects receiving dialysis died. The median survival after the onset of haemodialysis was 37 months in the first time period (1982–1988), 47 months in the second period (1989–1995) and 67 months in the third period (1996–2002). The death rate in the first period was 4.3 times (95% CI, 2.1–8.9) as high and the second period was 2.9 times (95% CI, 1.5–5.8) as high as the most recent period, after adjustment for age, sex and ethnicity in a proportional-hazards analysis. The number of diabetic patients in CNMI who are receiving renal replacement therapy is rising rapidly. Considerable improvement in survival after the onset of haemodialysis has occurred over the past 21 years. KEY WORDS: Carolinians, Chamorros, end-stage renal disease, survival, type 2 diabetes. INTRODUCTION Diabetes mellitus is a growing public health problem in Micronesia where diabetes-related complications are becoming a major cause of morbidity and mortality. 1–3 Studies in Nauru provide extensive information about diabetes and its complications in one Micronesian com- munity. Among Nauruans, the prevalence and incidence of type 2 diabetes, determined by systematic screening of the population, is among the highest in the world; sec- ond only to the Pima Indians. 4 Elsewhere in Micronesia, however, data regarding diabetes and its complications are sparse or nonexistent. The remoteness of many Micronesian populations is, in part, responsible for the paucity of data. Micronesia is a collection of more than 2000 islands that cover three million square miles of Pacific Ocean and extend from the Marshall Islands in the east to Palau in the west and from the Mariana Islands in the north to the Caroline Islands in the south. The population of Micronesia is presently just over 500 000 people and it is expected to double within 30 years. Formerly a US Trust Territory in its entirety, Micronesia is now a collection of loosely associated island nations. The US Commonwealth of the Northern Mariana Islands (CNMI) consists of 14 islands in the Mariana archipelago. Most of the population of CNMI lives on the island of Saipan, with a few thousand others living on the nearby islands of Rota and Tinian. The other 11