Disparities in the burden, outcomes, and care of chronic kidney disease

Abstract

Purpose of review Racial/ethnic and socioeconomic disparities in chronic kidney disease (CKD) have been documented for decades, yet little progress has been made in mitigating them. Several recent studies offer new insights into the root causes of these disparities, point to areas where future research is warranted and identify opportunities for changes in policy and clinical practice. Recent findings Recently published evidence suggests that geographic disparities in CKD prevalence exist and vary by race. CKD progression is more rapid for racial/ethnic minority groups as compared to whites and may be largely, but not completely, explained by genetic factors. Stark socioeconomic disparities in outcomes for dialysis patients exist, and vary by race, place of residence and treatment facility. Disparities in access to living kidney donation may be driven primarily by the socioeconomic status of the donor as opposed to recipient factors. Summary Recent studies highlight opportunities to eliminate disparities in CKD, including efforts to direct resources to areas and populations where disparities are most prevalent, efforts to understand how to best use emerging information on the contribution of genetic factors to disparities, and continued work to identify modifiable environmental, social, and behavioral factors for targeted interventions among high-risk populations.

Hemodialysis Disparities in African Americans: The Deeply Integrated Concept of Race in the Social Fabric of Our Society

“…It is important to mention that these designations are embedded in a European world-view and the norms that follow through that lens would likely differ if viewed through another cultural lens. Therefore, it is not surprising that health outcomes stratified by race and ethnicity are less likely a result of biology and more strongly influenced by one's social position and the associated socioecologic determinants of health such as discrimination, residential segregation (92), educational and income inequalities (93)(94)(95)(96), imbalance in community level assets, access to care (5), healthcare resources (78,97,98), and exposure to environmental toxins (6,99). Additional factors include health system barriers, unconscious provider bias, stereotype threat, medical mistrust, and patient beliefs and behaviors (63,65,100,101).…”

Racial differences in acute kidney injury of hospitalized adults with diabetes

“…hypertension, hyperlipidemia), and socioeconomic status (7). Acute kidney injury (AKI) is also a well-described risk factor for CKD, which reciprocally confers an increased risk of AKI(8).…”

Burden, access and disparities in kidney disease

“…In many settings, rates of kidney disease and the provision of its care are defined by socio‐economic, cultural and political factors leading to significant disparities (Crews et al . ). World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management.…”