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As a whole, the healthcare system treats the Black community differently. While the disparities in health resources and services are being addressed, from the clinic to the national government level, it is harder to change how kidney disease affects African Americans. Vulnerability to chronic kidney disease is ingrained in DNA, and, while medical studies have made progress and genetic testing for gene mutations is now available, treatments are not yet available.
What is chronic kidney disease? What are these healthcare disparities? What gene mutations make Blacks more susceptible to this disease? Read on for these answers and more.
What is Kidney Disease?
Kidney damage causing 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. Becoming severely dehydrated often or recurring urinary tract or bladder infections can contribute to kidney disease over time. Polycystic kidney disease is one type of this disease that is usually genetic, causes more kidney damage over time, and affects how well the kidneys filter blood.
When kidney function is compromised, one or both kidneys cannot filter blood as efficiently as necessary to keep you healthy. Toxins build up in the blood, making you feel sick and possibly damaging other organs. The condition may be temporary while you recover from an illness, but more often, the disease is long-term with a gradual loss of function.
Some signs of chronic kidney disease are easy to overlook because they can mimic symptoms of minor illnesses like dehydration. This could be feeling tired or having 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 address these with a healthcare provider as soon as possible.
- Nausea or vomiting
- Cramps or muscle spasms, especially in the lower legs
- Confusion or trouble concentrating
- Trouble sleeping
- Dry, itchy skin
- Metallic taste or poor appetite
Risk Factors for CKD
Many people are at increased risk of developing chronic kidney disease and aren’t aware, while many others already have lowered kidney function without realizing it. Kidney disease progresses quickly without treatment. If you have one or more risk factors listed below, you should discuss them with your healthcare provider.
- High blood pressure
- Heart disease
- Over age 60
- Long-term use of pain relievers (particularly NSAIDs)
- Family history
- Ethnic background
Kidney Disease Treatment
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 to no function. Complete kidney failure requires dialysis to remove the waste product from your blood and an eventual kidney transplant. CKD treatment will vary depending on kidney function, co-existing health conditions, and other factors. You will work closely with your kidney doctor, any other specialists needed, and your primary provider to ensure you can manage the progression of the disease as best as possible.
Why is Kidney Disease Different for Black People?
Any chronic illness brings many challenges, but Blacks facing CKD experience more of them. From biology and DNA to racism within the healthcare system, kidney disease differs for the Black community.
Racism has been ingrained within the healthcare system for decades. There are several ways in which Blacks experience systemic prejudice, including accessing or being offered healthcare resources or services.
Access to Healthcare
It is widely reported by research organizations, university publications, and others that healthcare disparities exist within the black community. Those living in poorer neighborhoods may not have access to well-equipped medical clinics or adequate health insurance. Many black Americans don’t have a primary healthcare provider for preventative care, even for such conditions as high blood pressure, or access to specialists like a kidney doctor, so early detection of most chronic illnesses is challenging.
The black population is less likely to receive testing for chronic illness if suspected, even routine urine tests, or be referred for advanced care if warranted. These healthcare access disparities are being addressed, but change has been slow, and has led to lower quality of life for many suffering from a long list of diseases and not just those affecting the kidneys.
Diagnosing Kidney 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 function. A long-standing belief within the medical community was that GFR results were higher for African American adults. There weren’t many clinical studies to support this theory, so a task force was created to reassess the notion. After ten months, no evidence was found, and the task force recommended that all healthcare 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 Transplants
NBC reported in February 2023 that changes had been made to how patients’ priority is determined when added to the kidney transplant waiting list. According to the report, Dr. Martha Pavlakis says that “the inclusion of race variables is inaccurate,” and the outdated GFR lab test is now banned. African Americans on the list will be credited with time, meaning they could receive a kidney transplant one to two years sooner than expected. Before this change, the average wait time for an African American was 64 months compared to 37 months for a non-Hispanic white person.
A study published by Current Transplantation Reports supports this, citing “structural racism” as a leading cause of Blacks’ lower access to living donor kidney transplantation (LDKT).
Diabetes and hypertension (high blood pressure) are the leading causes of kidney diseases. The Office of Minority Health at the US Department of Health and Human Services reports that there are nearly twice as many black Americans with diabetes than non-Hispanic white people. According to the American Heart Association, over half have high blood pressure. It is more likely to develop early and become more severe. Many fall into both categories as one is a risk factor for the other.
Other conditions are also risk factors for kidney disease, like cardiovascular diseases, disproportionately affecting the black community. Black women are especially vulnerable to autoimmune diseases, like Lupus, that attack the kidneys and sometimes lead to using NSAIDs to control joint pain.
Treatment for chronic kidney disease often requires treatment of underlying health conditions, which requires access to consistent healthcare and medications. In some communities experiencing economic disparities, this can create many challenges.
In addition to underlying medical conditions, a common gene mutation may increase their risk. Dr. Opeyemi Olabisi of Duke University describes this mutation and its effects for the New York Times. The APOL1 gene is found in the DNA of those with sub-Saharan or Afro-Caribbean ancestry as a defense against African trypanosomiasis. This disease, also called sleeping sickness, is caused by a parasite. While the normal gene has been helpful for millennia, those that 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 made current generations more usceptible to sickle cell disease.
Medications currently being tested could help target these gene mutations to help treat chronic kidney disease in the black community at its source. Genetic testing may help determine who is at risk, but there’s no guarantee that a person with both mutations will develop the disease. However, knowing about their vulnerability could lead to high blood pressure and added stress, leading to another risk factor.
How Are Things Changing?
Thankfully, the healthcare system is slowly changing to ensure everyone gets the care they deserve regardless of race or income level. These changes are slow but happening nonetheless. Just a few of the transformations we’ve seen so far include the following:
- Addressing Social and Economic Disparities
- Better Access to Culturally-Competent Care
- Healthcare Education
- Preventative Medicine
- Better Understanding of Kidney Function
- Faster Referrals for Kidney Transplant
- Less Bias in Receiving a Transplant
- Genetic Testing When Appropriate
- Targeting of the APOL1 Gene
Chronic Kidney Disease in African Americans
It may take time for every community to see the effects of reform. Still, we hope that more awareness of these disparities will soon affect even more positive change, allowing those suffering from kidney disease to experience a better quality of life through every stage of the condition. Black Health Matters has the privilege of working with amazing people and organizations to help spread this awareness.
If you or someone you know is diagnosed with chronic kidney disease, know that there are studies and tests underway for new treatments and changes within healthcare every day to make getting those treatments easier once they are available.