Survival of the Fittest: Addressing the Disparities in the Burden of Chronic Kidney Disease

Abstract

The prevalence of chronic kidney disease (CKD) is increasingly becoming recognized as a global health concern as well as a critical determinant of poor health outcomes. Decreased access to health care and low socioeconomic status (SES) worsen the adverse effects of biologic or genetic predisposition to CKD. All the studies used were retrieved using the PubMed database. The literature suggests that in developing and developed countries, lower SES is inversely proportional to CKD. It shows an inconsistent relationship between CKD and race; that is, there may or may not be a relationship between these two variables. In the United States (US), the prevalence of the early stages of CKD is similar across different racial/ethnic groups. However, the preponderance of end-stage renal disease (ESRD) is higher for minorities than their non-Hispanic white counterparts. Further investigation is required to understand the role of racial disparities and CKD as well as to understand the significant difference seen in the incidence when progressing from CKD to ESRD. It is necessary to recognize how lower SES and racial/ethnic disparity may result in the impediment of appropriate disease management. A possible approach is the use of the biopsychosocial model, which integrates biological, individual, and neighborhood factors. A practical method of providing appropriate care to these populations will require economically feasible prevention strategies as well as extending the scope of dialysis by the implementation of cheaper alternatives.

Association between socioeconomic position and cystatin C in the Heinz Nixdorf Recall Study

“…Previous studies have produced convincing evidence for an inverse relationship between SEP and manifest kidney disease 33 , but few studies have examined the association between SEP and cystatin C as a subclinical biomarker for early kidney disease. Peralta et al (2006) have reported an association between income and cystatin C in African Americans consistent to the results of the present study 34 .…”

Demographic and clinical profile of black patients with chronic kidney disease attending a tertiary hospital in Johannesburg, South Africa

“…Inclusion criteria included patients who were >18 years of age, CKD stages 1–4, who had controlled hypertension (blood pressure < 140/90 mm Hg) and diabetes mellitus (HbA1C < 7%), attending the KOPD clinic for at least 6 months and were able to provide informed consent. Patients who had active infections, active malignancies, autoimmune diseases and who were not black were excluded, black patients have an increased risk of developing CKD and end stage kidney disease (ESKD) at significantly higher rates than other races [ 13 , 15 ].…”

“…Studies have shown that African-Americans have a 2- to 4-fold greater risk for end stage kidney disease (ESKD) requiring renal replacement therapy than their white counterparts [ 10 , 11 ]. Individuals of black ethnicity due to their genetics, including the presence of APOL1 high-risk genotypes, are at higher risk of death due to CKD as a result of social, economic and medical causes [ 12 , 13 ]. African ancestry has been associated with higher serum creatinine levels, lower eGFR estimates and more rapid CKD progression [ 14 , 15 ].…”

Progression of chronic kidney disease among black patients attending a tertiary hospital in Johannesburg, South Africa

“…Patients who had active infections, active malignancies, autoimmune diseases and who were not black were excluded. Black patients have significantly higher rates of more rapid CKD progression and ESKD than other races (21, 22), hence they were the focus of this study.…”