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Leslie Spry, M.D., FACP Headshot

Silent Epidemic: Kidney Disease in the African-American Population

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Talking about race is never just black and white, but when it comes to health, one thing is crystal clear: racial disparities exist and a variety of factors, including genetics, seem to play a role.

Black Americans are three times more likely than White Americans to develop kidney disease and to require dialysis. This is both a troubling statement and a sad reality for the African-American population. Of great concern is that this racial disparity remains constant across all age groups. It may not make many headlines, but it needs to be brought to the attention of the public.

The two most common causes of kidney disease in the black population are the same as other races: diabetes and high blood pressure, in that order. And yet, blacks are twice as likely as whites to develop diabetes and also more likely to develop kidney failure from high blood pressure and diabetes than any other racial group.

New research has also identified genetic differences in the African-American population that seem to further explain the racial disparity. Genetic markers such as the APOL1 gene occur with much greater frequency in the African-American population. These markers may explain why kidney disease seems to progress more rapidly in the black population than any other racial group. Additionally, research has shown that African-American females are more than twice as likely to deliver low birth weight babies and this has been linked with an increase in the incidence of kidney disease. Other factors that are associated with a greater risk of kidney failure include socioeconomic disparity and lack of access to medical care.

Given the staggering rates of kidney disease in the African-American community, African Americans need to pay particular attention to their kidney health. Kidney disease often has no symptoms until it is very advanced, so it can go unnoticed. Diabetes and high blood pressure are two of the leading causes of kidney disease, but the news is not all grim. Lifestyle changes can make a big difference in reducing one's risk for developing kidney disease and early testing and treatment can slow or prevent the progression of kidney disease and its complications.

As the saying goes, an ounce of prevention truly is worth a pound of cure. When it comes to kidney disease, awareness and prevention are critical to reducing this racial disparity. Many prominent African Americans are helping the National Kidney Foundation to get the word out, including actor, comedian and National Kidney Foundation spokesperson, Nick Cannon, who said, "I never gave my kidneys a second thought until I ended up in the hospital. The kidneys filter out toxins in the blood, acting as the body's purifier, but unless they stop working, so many of us pay no attention. With such alarming numbers of people affected by kidney disease and a disparity in the African-American population, we can't afford to ignore this anymore."

The National Kidney Foundation offers many resources for kidney disease prevention and recently launched a new web portal to bring attention to the staggering kidney disease epidemic among African Americans. There are many reasons to pay attention to your kidneys, regardless of the color of your skin.

Here are three steps that you can take to prevent kidney disease and to detect it early in order to slow the progression to kidney failure:

  1. Ask your family for information. Talk to your parents, brothers, sisters, aunts and uncles about whether anyone in your family has high blood pressure, diabetes or kidney disease. Ask if anyone has had a kidney transplant or been on dialysis. Family history is one of the most important risk factors for kidney disease.
  2. Get tested. If you have high blood pressure or diabetes, a family history of kidney failure or are over age 60, you should be tested. There are two simple kidney tests that should be done annually. Ask your healthcare provider for a blood test to calculate an estimated glomerular filtration rate (eGFR), which shows how well your kidneys are filtering wastes from the blood. Also, request that your healthcare provider checks for protein in the urine, one of the earliest signs of kidney damage. Together, these provide an assessment of your overall kidney health.
  3. Adopt a healthy lifestyle. If you have risk factors for kidney disease or are living with kidney disease, you can protect your kidneys and preserve your kidney health by following a healthy lifestyle. The DASH diet has been shown to have the greatest effect on blood pressure in the black population. Adopt a low salt DASH diet and try to maintain a healthy body weight. Increase your physical activity to incorporate an extra 150 minutes of physical activity per week. Don't smoke. Avoid alcohol to excess and steer clear of street drugs.

No matter what your skin color, race or ethnicity, kidney disease is a growing public health concern and I urge you to pass along this information and to share the resources found on the National Kidney Foundation's website. Let's bring this epidemic to everyone's attention and act together as a community that transcends color lines in order to protect the health of our African-American families.

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