Chronic kidney disease (CKD) affects an estimated 37 million people in the United States. Often, it begins and progresses silently, causing no obvious symptoms until kidney function is severely impaired. During early stages, up to nine in 10 people aren’t aware that they have it.
If kidney disease is caught early and treated properly, serious problems may be avoided. Once kidneys fail, ongoing dialysis or kidney transplant is necessary. But barriers to care are highest for Black and Hispanic people with advanced kidney disease, and also for younger adults ages 22 to 44, according to a recent study.
How does kidney disease affect the body?
As a doctor who focuses on patients with kidney disease, I’ve found that it helps to explain a few basics. Our kidneys have several jobs. Their most important task is to regularly remove toxins from the bloodstream and excess water from the body by making
If you have CKD, your kidneys are not removing toxins from your blood as well as they should. At its most severe, this can progress to end-stage kidney disease (ESKD), which is when the filtering capacity of your kidneys is reduced enough to make you feel ill.
If this occurs, two main forms of treatment can replace your kidney function: dialysis or a kidney transplant. Dialysis can be performed at a treatment center, or at home after appropriate training. Transplant surgery and post-surgical care occur at specialized centers.
What causes kidney disease?
High blood pressure, diabetes, and high cholesterol are three common risk factors for developing chronic kidney disease. Smoking, obesity, and frequent use of over-the-counter anti-inflammatory medicines, such as ibuprofen or naproxen, worsen kidney function over time.
Severe cases of COVID-19 requiring hospitalization have emerged as a separate risk factor for CKD. And genetic factors may predispose a person to kidney disease as well.
Gaps in kidney care are contributing to health disparities
Statistics show that people who are non-Hispanic Black, Hispanic, and Native American bear a disproportionate burden of kidney disease. For example:
- For every white person who develops ESKD, three Black people develop it.
- While non-Hispanic Black patients make up only 13% of the US population, they represent 35% of people currently on dialysis.
- Among patients initially on a wait list for a kidney transplant in 2014, median wait times were approximately 64 months for Black patients, 57 months for Hispanic patients, and 37 months for white patients.
Most likely, disparities in CKD reflect a combination of the social determinants of health, genetics, and a higher burden of other diseases that contribute to kidney disease, such as high blood pressure and diabetes. Barriers to getting proper treatment — particularly early treatment — play a role, too.
A recent retrospective study in the American Journal of Kidney Medicine suggests age is also a factor. The researchers reviewed data from more than 800,000 patients who received dialysis at home, dialysis at a treatment center, or a kidney transplant between 2011 and 2018. They found
- white people in the study were more likely than people of color to use at-home dialysis or receive a kidney transplant within 90 days.
- the care gap was greatest among adults ages 22 to 44. Black patients in this age group were 79% less likely, and Hispanic patients were 53% less likely, than white patients to receive a kidney transplant within 90 days.
These disparities may be driven partly by the fact that Black and Hispanic patients are less likely to receive appropriate early-stage kidney care, and by differences in insurance. They may also be less likely to have access to a living kidney donor. An important limitation of this study is that these findings cannot be applied to other minority groups.
The bottom line
The good news is that most people can prevent kidney disease by following healthy lifestyle habits, such as eating a low sodium diet, getting moderate exercise, not smoking, and minimizing alcohol intake. If you have high blood pressure, diabetes, high cholesterol, or heart disease, you should be tested for kidney disease once a year. High blood pressure and diabetes — which occur more often among Black Americans and people of color in the US than among white Americans — harm kidneys. Studies such as the one described above increase our understanding of health disparities in kidney disease, with the hope of one day coming up with an equitable solution for everyone, no matter their background or age.
Bible verses for today’s meditation and inspiration: Matthew E. McLaren
Suppose you find fifty righteous people living there in the city—will you still sweep it away and not spare it for their sakes? (Genesis 18:24) And the Lord replied, “If I find fifty righteous people in Sodom, I will spare the entire city for their sake.” (Genesis 18:26)
And be sure to say, ‘Look, your servant Jacob is right behind us.’” Jacob thought, “I will try to appease him by sending gifts ahead of me. When I see him in person, perhaps he will be friendly to me.” (Genesis 32:20)
to say to you: ‘Please forgive your brothers for the great wrong they did to you—for their sin in treating you so cruelly.’ So we, the servants of the God of your father, beg you to forgive our sin.” When Joseph received the message, he broke down and wept. (Genesis 50:17)
“Forgive my sin, just this once, and plead with the Lord your God to take away this death from me.” (Exodus 10:17)
Pay close attention to him, and obey his instructions. Do not rebel against him, for he is my representative, and he will not forgive your rebellion. (Exodus 23:21)
Moses Intercedes for Israel The next day Moses said to the people, “You have committed a terrible sin, but I will go back up to the Lord on the mountain. Perhaps I will be able to obtain forgiveness for your sin.” (Exodus 32:30) So Moses returned to the Lord and said, “Oh, what a terrible sin these people have committed. They have made gods of gold for themselves. (Exodus 32:31) But now, if you will only forgive their sin—but if not, erase my name from the record you have written!” (Exodus 32:32)
The Lord passed in front of Moses, calling out, “Yahweh! The Lord! The God of compassion and mercy! I am slow to anger and filled with unfailing love and faithfulness. (Exodus 34:6) I lavish unfailing love to a thousand generations. I forgive iniquity, rebellion, and sin. But I do not excuse the guilty. I lay the sins of the parents upon their children and grandchildren; the entire family is affected— even children in the third and fourth generations.” (Exodus 34:7)
And he said, “O Lord, if it is true that I have found favor with you, then please travel with us. Yes, this is a stubborn and rebellious people, but please forgive our iniquity and our sins. Claim us as your own special possession.” (Exodus 34:9)
just as he does with the bull offered as a sin offering for the high priest. Through this process, the priest will purify the people, making them right with the Lord, and they will be forgiven. (Leviticus 4:20) Then he must burn all the goat’s fat on the altar, just as he does with the peace offering. Through this process, the priest will purify the leader from his sin, making him right with the Lord, and he will be forgiven. (Leviticus 4:26)
Then he must remove all the goat’s fat, just as he does with the fat of the peace offering. He will burn the fat on the altar, and it will be a pleasing aroma to the Lord. Through this process, the priest will purify the people, making them right with the Lord, and they will be forgiven. (Leviticus 4:31) Then he must remove all the sheep’s fat, just as he does with the fat of a sheep presented as a peace offering. He will burn the fat on the altar on top of the special gifts presented to the Lord. Through this process, the priest will purify the people from their sin, making them right with the Lord, and they will be forgiven. (Leviticus 4:35)
The priest will then prepare the second bird as a burnt offering, following all the procedures that have been prescribed. Through this process the priest will purify you from your sin, making you right with the Lord, and you will be forgiven. (Leviticus 5:10) Through this process, the priest will purify those who are guilty of any of these sins, making them right with the Lord, and they will be forgiven. The rest of the flour will belong to the priest, just as with the grain offering.” (Leviticus 5:13)
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