Unraveling the racial disparities associated with kidney disease1

Abstract

In the United States, chronic kidney disease (CKD), and in particular end-stage renal disease (ESRD), represent a growing problem. Many other countries also have an increasing number of ESRD cases. Racial/ethnic disparities have been documented globally in the prevalence, incidence, and treatment of CKD, most extensively in the United States, but also in the United Kingdom, Australia, and New Zealand, among others. In many circumstances, these disparities are of a negative nature, that is, certain racial/ethnic groups fare worse than their white counterparts with respect to the treatment or outcome of CKD. However, in a few circumstances, they are of a positive nature, such as the survival advantage seen in minorities with ESRD compared with whites. The reasons for racial disparities in the prevalence, incidence, and treatment of CKD are not fully understood, although they are explained partly by coexisting medical conditions and modifiable risk factors, such as socioeconomic, lifestyle, and cultural. It is likely, however, that the complete picture incorporates a complex interaction between these sociocultural, genetic, and environmental factors. In a global society that prides itself on a high level of sensitivity and equality, there is an ethical and moral imperative to address the continuing racial/ethnic disparities in CKD and many of the factors underlying this epidemic. We review data highlighting the racial/ethnic disparities that exist in the incidence and treatment of CKD, with particular emphasis on ESRD. A better understanding of both the negative and positive racial/ethnic disparities may yield important insights, which can inform future research strategies and improve health outcomes for all patients afflicted with CKD.

Psychosocial Aspects of Chronic Disease

“…199,200 Norris and Agodoa 201 have developed a model highlighting how socioeconomic factors such as low income, poor education, residence in low-income areas, and poor access to health care are strong predictors of the development of ESRD. Not enough study has been given to the notion that differential quality of physician care may characterize programs in different neighborhoods.…”

Similar Outcomes among Black and White Renal Allograft Recipients

“…In the United States, renal allograft survival is significantly lower in black than in white patients, [5][6][7][8][9][10] which might be due to higher immunologic risk, poorer medication adherence, or decreased access to pre-and posttransplantation care. 8,[11][12][13][14][15][16][17][18][19][20][21][22][23] Whether black Canadian transplant recipients also have decreased transplant survival is unclear because there are no published data describing transplant outcomes among this patient group. A recent study comparing outcomes in Canada and the United States demonstrated that American transplant recipients had an increased risk for mortality.…”

Chronic Kidney Disease Prevention in Singapore

“…Indeed, racial differences in the prevalence and risk for chronic kidney disease are striking (14), and this has been extensively studied in the black population. Clear differences in various Asian ethnic groups have also been demonstrated in Hong Kong and Singapore (15,16).…”