By Aaron Allen, The Seattle Medium
Black Americans are disproportionately affected by kidney disease compared to all other races. Diabetes and hypertension are the most common risk factors for developing End Stage Kidney Disease (ESKD), with obesity/overweight being an important co-morbid condition. Compared to their White counterparts, African Americans have a higher prevalence of obesity/overweight 76.3% vs 68.5%, diabetes 18% vs 9.6%, including both physician-diagnosed and undiagnosed disease, and hypertension 43.3% vs 29.1%.
The explanations for the higher rates of kidney disease in African Americans have generally fallen into two major groups: higher rates of diseases such as diabetes and hypertension that lead to kidney disease.
According to Dr. Suzanne Watnick, Chief Medical Officer for the Northwest Kidney Centers, African Americans are three times more likely than White Americans to develop kidney failure and kidney disease can be triggered by several factors, but the major causes of kidney failure are diabetes and hypertension (high blood pressure).
“There are so many things that contribute to kidney failure and absolutely I think it is well recognized,” says Watnick. “We know that even for end stage kidney disease it is not only more common in the Black population than the white population, it is also more common in men than women. So yes, there are a lot of factors that go into the disparities in term of disparities there are a lot to think about.”
Kidney disease is not unique in having a clear difference among ethnic groups with respect to risks and outcomes. The same can be said for many chronic diseases including diabetes, heart failure, peripheral arterial disease, asthma, and cancer, as well as for pregnancy. The most recent report from the United States Renal Data Service shows an end-stage renal disease prevalence of 5,855 cases per million for African Americans, compared to 1,704 cases per million for white Americans. Unfortunately, despite significant advances in medical treatment, one of the major factors contributing to these disparities lack of access to insurance and medical care, which can lead to delayed diagnosis and treatment.
“I have never experienced [racism or racially disparate medical treatment] and I don’t know how I would say it, but I’m just going to say it. I have amazing insurance and I am a high-income person,” says John Mosby, president of Highline College, who suffers from three chronic conditions — kidney disease, diabetes, and hypertension. “So those two factors put me in a different kind of category, so I receive exceptional care. But I know I am very lucky because that is not everybody. But my insurance and my visibility, the position I hold have helped me and I must admit that.”
“I will say that in terms of how my conditions aligns with other Black people, I received great care about taking care of John Mosby the patient, but in terms of our community there is just not a lot of information out there,” Mosby continued.
As Science and medicine learn more about the genetics and biology of kidney disease in African Americans, they (genetics and biology) play a relatively minor role in their excess risk. Social determinants of health, race, and racism are equally, if not more important in explaining the risk of kidney disease in African Americans relative to white Americans.
“Part of it is in our community there hasn’t been a significant amount of trust in the healthcare field,” says Mosby. “We have seen this through the years from the Tuskegee experiments to now. We know in our community that diabetes and hypertension run rampant and those are the majority contributors to kidney failure, right. And there is not a lot of education in our community although it is improving but there hasn’t been a lot of education about kidney disease and its effect on our community.”
One of the first lines in prevention of kidney disease, and many other chronic diseases, is diet. From a dietary perspective, most authorities agree that what we put into our bodies is the fundamental aspect of our overall health. As a community, African Americans pride themselves on culinary traditions and generations of people were raised with a certain pallet for what is called “soul food”. Unfortunately, soul food is typically rich in sodium which can devastate our biological systems.
“Our head dietician always talked about the evils of sodium for decades,” says Dr. Watnick. “Taking a step back the main causes of kidney disease are diabetes, type 2 diabetes, and high blood pressure in this country. And that accounts for about three quarters of all people who start maintenance dialysis but this cuts across all racial categories interestingly and across genders and what you eat makes a huge difference in terms of developing diabetes, developing high blood pressure, and so changing what you eat will not always stop a diagnosis. Sometimes it can prevent it but changing what you eat can help to change the progression of problems with the disease.”
According to Dr. Watnick, one thing that is beneficial to people suffering from kidney disease or those who may be at end stage kidney disease is that advocates have made sure that they have equal access to dialysis treatment, but that is something that addresses quality of life after diagnosis rather than a person’s overall health.
“The fortunate thing in this country is policy was passed in legislation in 1972-73 that the Medicare program actually covers people for dialysis no matter what their age or station,” says Dr. Watnick. “It’s one of the few diseases specific benefits for people in this country. We work so that everybody who needs this life saving therapy can receive it and that is certainly a good thing.”
“But it will take patients, families, clinicians, and community health advocates working cooperatively to truly eliminate disparities in rates of kidney disease and its outcomes,” Dr. Watnick concluded.