My first exposure to kidney disease and its impact on communities of color occurred when I was in high school. An elderly neighbor, who was like a grandfather to me, had been diagnosed with kidney failure. At about the same time, my older first cousin, who had children about my age, was starting dialysis due to kidney failure attributed to hypertension. She would go on to get a kidney transplant. If you ask any African American, he or she is likely to have at least one relative with kidney disease requiring dialysis or transplantation.
Disparities in kidney disease not noted in medical literature until early 1980s
When I began my training in nephrology (kidney disease) in 1993 in Birmingham, Alabama, it was already apparent to me that people of African descent were much more likely to suffer from kidney disease than people of European descent. The dialysis units in Birmingham were filled with black and brown people of all ages, and sometimes multiple family members. In one of the dialysis units, my patients included an African American grandfather and grandson, an African American mother and daughter, and two African American sisters.
Nephrologists had noted anecdotally the striking disparities in rates of kidney disease in African Americans relative to white patients, but it was not widely reported in the medical literature until 1982, when a report titled “Racial Differences in the Incidence of Treatment for End-Stage Renal Disease” was published in the New England Journal of Medicine. The authors found that in Jefferson County, Alabama, the risk of end-stage renal disease due to hypertension was approximately 18 times greater for African Americans relative to whites.
Underlying conditions do not adequately explain disparities
The explanations for the higher rates of kidney disease in African Americans have generally fallen into two broad