CKD and ESRD in US Hispanics

Abstract

Hispanics are the largest racial/ethnic minority group in the United States, and they experience a substantial burden of kidney disease. Although the prevalence of chronic kidney disease (CKD) is similar or slightly lower in Hispanics than non-Hispanic whites, the age- and sex-adjusted prevalence rate of end-stage renal disease is almost 50% higher in Hispanics compared with non-Hispanic whites. This has been attributed in part to faster CKD progression among Hispanics. Furthermore, Hispanic ethnicity has been associated with a greater prevalence of cardiovascular disease risk factors, including obesity and diabetes, as well as CKD-related complications. Despite their less favorable socioeconomic status, which often leads to limited access to quality health care, and their high comorbid condition burden, the risk for mortality among Hispanics appears to be lower than for non-Hispanic whites. This survival paradox has been attributed to a complex interplay between sociocultural and psychosocial factors, as well as other factors. Future research should focus on evaluating the long-term impact of these factors on patient-centered and clinical outcomes. National policies are needed to improve access to and quality of health care among Hispanics with CKD.

Long‐term outcomes after liver transplantation in the Hispanic population

“…Our findings of a survival advantage may not be unique to LT and may fit with what has been termed as the “Hispanic paradox”. Studies that have examined the Hispanic population in other settings, found a survival advantage in the context of a disadvantageous risk factor profile. Several reasons have been proposed to explain this paradox .…”

New research directions on disparities in obesity and type 2 diabetes

“…17,18 Lack of access to care in non-Hispanic Blacks is associated with not meeting blood pressure targets. 21,22 Within these groups, men have notably higher rates of lower extremity amputation and myocardial infarction than women. 9 States, with some improvements across all affected groups, disparities remain.…”

“…They are observed most clearly in non-Hispanic Blacks, who have substantially higher rates of end-stage renal disease (ESRD), amputation, and stroke; 20 and in Hispanics and Asian Americans who have elevated ESRD complications. 21,22 Within these groups, men have notably higher rates of lower extremity amputation and myocardial infarction than women. The pattern of disparities in complications according to markers of social class and education does not appear to be consistent.…”

Trends in Mortality Among Patients Initiating Maintenance Dialysis in Puerto Rico Compared to US States, 2006-2015

“…Although the incidence of end-stage kidney disease is 34% higher in US Hispanics than non-Hispanics, the latter have a lower mortality rate following initiation of dialysis (107 vs 206 per 1,000 patient-years). 1,2 Outcomes have not been examined in Puerto Rico, a US territory where 4 million Hispanic Americans reside. Puerto Rico outperforms the US states and the District of Columbia ("states" hereafter) on some measures of coverage and access, 3 but substantial problems with quality of care have been documented.…”