In general, the health care system treats the black community differently. Until disparities in health care resources and services are addressed, from the clinic to the national government level, it will be more difficult to change how kidney disease affects African Americans. Vulnerability to CKD is rooted in DNA, and although medical research has advanced and genetic testing for gene mutations is now available, a cure is still not available.
What is chronic kidney disease? What are these health disparities? Which gene mutations make blacks more susceptible to this disease? Read these answers and more.
What is kidney disease?
Kidney damage that causes chronic kidney disease (CKD) is more common than you think. Diabetes and high blood pressure are the two most common causes, but many autoimmune disorders (like lupus) also target the kidneys. Often severe dehydration or recurrent urinary tract or bladder infections can contribute to kidney disease over time. Polycystic kidney disease is a type of this disease that is usually genetic, causes more kidney damage over time, and affects how the kidneys filter blood.
When kidney function is compromised, one or both kidneys can’t filter the blood as efficiently as necessary to maintain your health. Toxins build up in the blood, making you feel sick and possibly damaging other organs. The condition can be temporary while you recover from the illness, but more often the illness is long-term with a gradual loss of function.
General symptoms
Some signs of chronic kidney disease are easy to ignore because they can mimic the symptoms of minor illnesses, such as dehydration. This can be a feeling of tiredness or the presence of dark urine. If you already have diabetes, you may be used to swelling in your lower legs. However, some symptoms are a warning sign of chronic kidney disease, and you should seek medical attention as soon as possible.
- Nausea or vomiting
- Jerking or muscle spasms, especially in the lower legs
- Confusion or difficulty concentrating
- Sleep disturbance
- Dry, itchy skin
- Metallic taste or poor appetite
Risk factors for CKD
Many people have an increased risk of developing chronic kidney disease and are unaware, while many others already have reduced kidney function without realizing it. Kidney disease progresses rapidly without treatment. If you have one or more of the risk factors listed below, you should discuss them with your healthcare provider.
- diabetes
- high blood pressure
- heart disease
- Over 60 years old
- Long-term use of pain relievers (especially NSAIDs)
- family history
- Ethnic origin
Treatment of kidney diseases
The five stages of kidney disease range from very little damage and normal function in the early stages to end-stage kidney disease with little or no function. Complete kidney failure requires dialysis to remove waste from your blood and eventually a kidney transplant. Treatment for CKD will vary depending on kidney function, coexisting health conditions, and other factors. You will work closely with your kidney doctor, any other necessary specialists, and your primary care provider to ensure that you can manage the progression of the disease as well as possible.
Why is kidney disease different for blacks?
Any chronic illness brings many challenges, but black people with CKD experience more of them. From biology and DNA to racism in the health care system, kidney disease is different for the black community.
Systemic racism
Racism has been entrenched in the healthcare system for decades. There are several ways in which Black people experience systemic prejudice, including receiving or being offered health care resources or services.
Access to health care
Health disparities within the black community are widely reported by research organizations, university publications, and others. Those who live in poorer neighborhoods may not have access to well-equipped medical clinics or adequate health insurance. Many black Americans do not have a primary care provider for preventive care, even for conditions such as high blood pressure or specialists such as a kidney doctor, so early detection of most chronic conditions is difficult.
Black populations are less likely to be tested for chronic disease if suspected, even routine urine tests, or referred for intensive care if warranted. These disparities in access to health care are being addressed, but change is slow and has resulted in reduced quality of life for many who suffer from a long list of diseases, and not just those affecting the kidneys.
Diagnosis of renal failure in African Americans
GFR is a standard blood test that measures the glomerular filtration rate, giving healthcare providers an estimate of how well your kidneys are working. It has long been believed in the medical community that GFR results are higher for African-American adults. There wasn’t much clinical research to support this theory, so a task force was formed to reevaluate the concept. Ten months later, no evidence was found, and the task force recommended that all health care providers immediately apply the same GFR equations to both African-American and Caucasian patients. These tests are now more accurate and early detection is much easier.
Racial bias in transplantation
NBC reported in February 2023 that changes were made to how patients are prioritized when added to the kidney transplant waiting list. According to the report, Dr. Martha Pavlakis says “the inclusion of racial variables is inaccurate” and the outdated GFR lab test is now banned. African-Americans on the list will be timed, meaning they could receive a kidney transplant a year or two sooner than expected. Before this change, the average wait time for an African-American was 64 months, compared to 37 months for non-Hispanic whites.
A study published by Current Transplantation Reports confirms this, citing “structural racism” as a major reason for low access to living donor kidney transplantation (LDKT) for blacks.
Co-existing conditions
Diabetes and hypertension (high blood pressure) are the main causes of kidney disease. The U.S. Department of Health and Human Services’ Office of Minority Health reports that the number of black Americans with diabetes is nearly twice that of non-Hispanic whites. More than half have high blood pressure, according to the American Heart Association. It is more likely to develop early and become more severe. Most people fall into both categories because one is a risk factor for the other.
Other conditions are also risk factors for kidney disease, such as cardiovascular disease, which disproportionately affects the black community. Black women are particularly vulnerable to autoimmune diseases such as lupus, which attack the kidneys and sometimes lead to the use of NSAIDs to control joint pain.
Treatment of chronic kidney disease often requires treatment of underlying health conditions, which requires access to consistent health care and medications. In some communities with economic disparities, this can create many challenges.
Genetic predisposition
In addition to underlying medical conditions, a common gene mutation can increase their risk. Dr. Opeyemi Olabisi of Duke University describes this mutation and its implications for the New York Times. The APOL1 gene has been identified in the DNA of people of sub-Saharan or Afro-Caribbean descent as a defense against African trypanosomiasis. This disease, also called sleeping sickness, is caused by a parasite. Although the normal gene has been useful for millennia, those who inherit two copies of the mutated gene are much more likely to develop kidney disease. This is similar to a gene that naturally developed an immune response against malaria, but makes current generations more susceptible to sickle cell disease.
Drugs currently being tested may help target these gene mutations to help treat chronic kidney disease at its source in the black community. Genetic testing can help determine who is at risk, but there is no guarantee that a person with both mutations will develop the disease. However, knowing their vulnerability can lead to high blood pressure and excessive stress, which will lead to another risk factor.
How do things change?
Fortunately, the health care system is slowly changing to ensure that everyone gets the care they deserve, regardless of race or income level. These changes are slow, but they are happening. Just a few of the transformations we’ve seen so far include:
- Addressing social and economic inequalities
- Better access to culturally competent care
- Health education
- Preventive medicine
- Better understanding of kidney function
- Faster kidney transplant referrals
- Less bias in receiving a transplant
- Genetic testing when appropriate
- Targeting the APOL1 gene
Chronic kidney disease in African Americans
It may take time for each community to see the impact of the reforms. However, we hope that greater awareness of these disparities will soon affect more positive changes, allowing kidney disease sufferers to experience a better quality of life at every stage of the condition. Black Health Matters is privileged to work with amazing people and organizations to help spread this awareness.
If you or someone you know has been diagnosed with chronic kidney disease, know that studies and tests are being conducted every day for new treatments and changes in healthcare to make these treatments easier when they become available.