Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Sep;68(9):1947-1957.
doi: 10.1007/s00125-025-06471-x. Epub 2025 Jun 27.

Differences in biopsy-proven diabetic kidney disease in individuals from Polynesia vs mainland France: a retrospective cohort study

Mathis Michel  1   2 , Adrien Flahault  3   4   5 , Vladimir Coliche  6 , Asma Alla  1 , Pascale Testevuide  6 , Ronan Delaval  6 , Christos Chatziantoniou  7 , Luc Frimat  1   8   9 , Hervé Sartelet  2   10 , Raphaël Kormann  11
Affiliations

Differences in biopsy-proven diabetic kidney disease in individuals from Polynesia vs mainland France: a retrospective cohort study

Mathis Michel et al. Diabetologia. 2025 Sep.

Abstract

Aims/hypothesis: Māori, a Polynesian population, have an earlier age of onset of type 2 diabetes and higher risk of diabetes-related complications compared with New Zealanders of European descent, and an increased incident rate ratio for end stage kidney disease. No data are available regarding the evolutive characteristics of diabetic kidney disease (DKD) in individuals living in French Polynesia.

Methods: We aimed to compare the retrospectively collected characteristics and outcomes of 92 and 63 individuals from French Polynesia and mainland France, respectively, presenting type 2 diabetes and biopsy-confirmed DKD, focusing on kidney survival, analysis of the Renal Pathology Society (RPS) score and participant survival.

Results: At the time of biopsy, Polynesian participants were younger (56.5 vs 66.9 years, p<0.001) and had a higher urinary protein/creatinine ratio (uPCR) (792 vs 452 mg/mmol, p<0.001), despite similar anti-proteinuria treatments and eGFR, and shorter time since diabetes diagnosis (8.7 vs 11.1 years, p=0.008). Polynesian participants had a more severe RPS classification (p<0.001). Median time from biopsy to kidney failure with replacement therapy was 1.59 years in the Polynesian population and 6.06 years in the mainland French population, accounting for death as a competing risk. Polynesian participants were at a higher risk of end stage kidney disease after adjustment for uPCR, eGFR, BMI and age at baseline (HR 2.45 [95% CI 1.23, 4.88]). In a clinical and histological reduced multivariable model, Polynesian origin, higher uPCR, lower eGFR, more severe RPS classification and presence of chronic vascular lesions were all independently associated with poorer kidney survival. The RPS classification was more strongly associated with kidney survival in participants from Polynesia (p value for interaction, 0.048), while a higher uPCR was more strongly associated with kidney survival in participants from mainland France (p value for interaction, <0.001). Older age and Polynesian origin were also independent risk factors for death.

Conclusions/interpretation: Starting at an earlier age, the evolutive course of DKD is also more severe in individuals from French Polynesia than from mainland Western Europe. Strong differences in clinical, histological and predictive outcomes of diabetic nephropathy were found in these different ethnic groups.

Keywords: Diabetic kidney disease; Kidney survival; Polynesian population; RPS classification.

PubMed Disclaimer

Conflict of interest statement

Acknowledgements: We wish to thank C. Ayav, from the REIN registry, for her help regarding the collection of data for kidney and participant survival in mainland France. We thank V. Panescu and M. Jamali, respectively, from the private hospitals of Gentilly (Nancy) and of Essey-les-Nancy, for their participation in the study. Data availability: Raw data and code are available upon reasonable request to the corresponding authors. Funding: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Authors’ relationships and activities: The authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work. Contribution statement: RK contributed to project conception. AA, PT, RD, CC, LF, HS and RK designed the work. MM, VC and AA acquired the clinical data. MM and HS acquired the histological data. AF analysed the results. MM, AF and RK wrote the manuscript. The manuscript was revised and the final version approved by all authors. AF and RK are the guarantors of this work and, as such, have full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

References

    1. Umanath K, Lewis JB (2018) Update on diabetic nephropathy: core curriculum 2018. Am J Kidney Dis 71(6):884–895. https://doi.org/10.1053/j.ajkd.2017.10.026 - DOI - PubMed
    1. Family Investigation of Nephropathy and Diabetes Research Group (2003) Genetic determinants of diabetic nephropathy: the family investigation of nephropathy and diabetes (FIND). J Am Soc Nephrol 14(7 Suppl 2):S202-204. https://doi.org/10.1097/01.asn.0000070077.63577.79 - DOI
    1. Scott A, Toomath R, Bouchier D et al (2006) First national audit of the outcomes of care in young people with diabetes in New Zealand: high prevalence of nephropathy in Maori and Pacific Islanders. N Z Med J 119(1235):U2015 - PubMed
    1. Atlantis E, Joshy G, Williams MH, Simmons D (2017) Diabetes among Maori and other ethnic groups in New Zealand. In: Dagogo-Jack S (ed) Diabetes mellitus in developing countries and underserved communities. Springer, Cham, pp 165–190. https://doi.org/10.1007/978-3-319-41559-8_10 - DOI
    1. Hobbs M, Ahuriri-Driscoll A, Marek L, Campbell M, Tomintz M, Kingham S (2019) Reducing health inequity for Māori people in New Zealand. Lancet 394(10209):1613–1614. https://doi.org/10.1016/S0140-6736(19)30044-3 - DOI - PubMed

LinkOut - more resources