Highlights in Minority Health
National Kidney Month
Reducing Racial and Ethnic Disparities in Chronic Kidney Disease
and Kidney Failure
Chronic kidney disease (CKD) reduces the body’s ability to filter
blood, remove waste and extra water, and keep beneficial
electrolytes in balance. Left untreated, CKD can lead to kidney
failure requiring kidney replacement treatment (dialysis or
transplantation) to maintain life. In 2001, approximately 10.9
million U.S. residents had CKD, 406,081 were receiving kidney
replacement therapy for kidney failure, 96,295 new cases of kidney
failure were diagnosed, and 99,000 deaths from kidney failure were
recorded. Annual death rates from cardiovascular diseases are
increased 10 – 100 times among persons with kidney failure.
CKD, kidney failure, and related disability, premature death, and
economic costs are growing public health problems that
disproportionately affect racial and ethnic minority populations in
the United States. African Americans, American Indians, Hispanics ,
and Asians are respectively 4.5, 3.6, 2, and 1.6 times more likely
to develop kidney failure than are whites. The ongoing epidemics of
CKD and kidney failure are due mainly to increased prevalence of
type 2 diabetes, poor control of diabetes and hypertension, and
delayed detection and treatment of the early stages of CKD. In
addition, racial and ethnic disparities in CKD, kidney failure, and
kidney replacement therapy (dialysis and transplantation) are caused
by a combination of biological, clinical, economic, social, and
cultural forces which lead to disproportionate burdens of suffering
among racial and ethnic minorities.
Effective clinical methods of early diagnosis and treatment for CKD
are available, not used often enough, and not equally accessible to
all patients who need them. Experts recommend tight control of blood
sugar in people with diabetes, lowering of blood pressure below
targets set for persons with hypertension who do not have kidney
disease, screening for early signs of CKD, and low protein diets to
prevent progression of CKD to kidney failure.
|Organized public health programs are also in place to support
actions taken by clinicians and individuals. Since 2000, the
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK),
Council of American Kidney Societies (CAKS), and other public and
private groups have conducted the National Kidney Disease Education
Program (NKDEP) to increase awareness, motivate action among health
care providers, policymakers, and populations at high risk for CKD.
To reduce extreme racial disparities in CKD, kidney failure, and
renal replacement therapy, the NKDEP has targeted African Americans
with hypertension, diabetes, and a family history of kidney failure.
The NKDEP is conducting pilot projects to develop educational
materials and methods in selected cities (Atlanta, GA; Baltimore,
MD; Jackson, MS; and Cleveland, OH).