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What to Know About Kidney Disease in African American People, Why is There an Increased Risk?



African American people are more likely to develop kidney disease than white people. This is due to structural racism and some genetic factors, among other things.


Although African American people make up just 13% of the United States population, they make up about 35% of people with kidney failure in the U.S. Kidney disease in African American people is a major public health issue.

That said, there are a number of strategies that can help prevent kidney disease and prolong survival in people who have it.


Keep reading to learn more about kidney disease in African American people, including reasons for the increased risk, symptoms, treatment options, and outlook.


Why is there an increased risk?


A number of factors contribute to the higher risk of kidney disease among African American people. They include the following.


Racism in medicine


Racism in medicine may increase the risk of African American people developing kidney disease. It may also increase the risk of people not receiving a correct diagnosis and treatment.


Numerous studies have documented a pattern of racism in medicine. For example, according to one 2021 paper, genetic variation is actually greatest between members of the same racial group, not between different racial groups. This indicates that race really is a social construct, not a biological reality.


However, doctors continue to treat race as a biological factor, attributing differences in the prevalence of certain medical conditions to race and genetics.


A 2016 study Trusted Source of doctors in training found that about half of them endorsed at least one racist myth about Black patients, such as the myth that they have thicker skin or feel less pain. These false ideas could directly affect their treatment of patients, such as by causing them not to correctly diagnose or treat pain.


Doctors score tests of kidney function in Black people differently, based on early but flawed research, suggesting that there might be some differences in kidney function. The estimated glomerular filtration rate (eGFR) test can measure how well the kidneys function. However, doctors apply a multiple to Black people’s scores that elevates their number, potentially making it appear as though their kidneys function better than they do.


In 2020, the American Society of Nephrology and the National Kidney Foundation created a task force to reevaluate the calculations that doctors use to measure kidney disease in African American people.


Lower access to healthcare


African American people may struggle to access quality healthcare due to a variety of factors Trusted Source, including:


  • residential segregation that may mean that they do not live near quality doctors

  • low incomes that may make it more difficult to afford healthcare

  • a low willingness to seek medical care when needed due to factors such as fear of racism


Structural racism


Structural racism is racism that is built into daily life. It often goes unnoticed, as it does not always require people to behave in explicitly racist ways.


Black American people are more likely to live in poor areas, in areas with low access to quality food, and in neighborhoods where they face exposure to toxic chemicals and environmental pollutants. Over time, this can erode their health.


Residential segregation persists thanks to historic and ongoing racial inequities. This includes the process of redlining, which excluded African American people from many neighborhoods. A 2013 study involving people receiving dialysis found that African American people who lived in highly segregated and low income neighborhoods had lower survival rates.


Chronic exposure to racism Trusted Source may steadily erode a person’s health. This can increase their risk of developing and dying from chronic conditions such as kidney disease. The theory of racism-related weathering argues that racism is a chronic stressor that steadily damages a person’s health throughout their life.


More risk factors


African American people, as a group, tend to have more risk factors for kidney disease than most other groups.


The risk factors include:

  • diabetes

  • obesity

  • a family history of diabetes or kidney disease

  • high blood pressure

It is important to note that racism in medicine and structural medicine may both contribute to the higher prevalence of these risk factors among African American people.


Genetic differences


According to a recent 2021 study Trusted Source, a variant in a gene called APOL1 is more common in people with recent African ancestry. Having this gene may increase the risk of developing chronic kidney disease.


Other research has found that kidney function may decline faster in Black American people. For example, a 2011 analysis Trusted Source involving people with atherosclerosis — a kidney disease risk factor — found higher rates of kidney decline among Black study participants.


Some researchers believe that this supports the notion of genetic differences in kidney function. However, other factors — such as low access to quality care, ongoing exposure to racist stress, or poor quality living environments — have a greater impact on these differences in kidney function.


Risk factors


Certain factors increase the risk of developing kidney disease.

They include:


  • having diabetes

  • having high blood pressure

  • being over the age of 60 years

  • being African American, Hispanic, Native American, or Asian American

  • having certain genetic kidney diseases or a history of kidney cancer

African American people are especially vulnerable to kidney disease from high blood pressure and diabetes. They are twice as likely as white people to develop diabetes, and they have a higher risk of certain diabetes risk factors.


Socioeconomic factors Trusted Source and chronic stress, including the stress of racism, may increase the risk of having conditions that cause kidney disease — especially diabetes and high blood pressure.

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