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.

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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.

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 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.

Learn more about racism in healthcare here.

Lower access to healthcare

African American people may struggle to access quality healthcare due to a variety of factors, 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

Learn more about socioeconomic factors affecting access to healthcare here.

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 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.

Learn more about the effects of racism on health and mental health here.

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.

Learn more about diabetes in African American people here.

Learn more about high blood pressure in African American people here.

Genetic differences

According to a recent 2021 study, 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 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.

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 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.

It is possible to have kidney disease and no symptoms, especially in the early stages. The symptoms can be subtle at first, and a person might blame them on fatigue or other medical conditions. For this reason, undergoing regular medical checkups can help a doctor diagnose the problem.

Some symptoms to watch for include:

  • new or worsening fatigue or concentration problems
  • difficulty sleeping
  • puffiness in the face, especially around the eyes
  • swelling in the feet
  • unexplained muscle pain or cramps
  • reduced appetite or unintentional weight loss
  • itchy skin
  • more frequent urination, particularly at night
  • urine that looks bubbly or foamy

Learn more about kidney disease here.

If a doctor suspects that a person has kidney disease, they may begin with a urine test to check for certain kidney disease markers. Albumin is a protein that, when present in the urine, may mean that the kidneys are damaged.

A blood test called an eGFR can measure how well the kidneys are filtering the blood. A score of about 60 indicates healthy kidneys, while a score below 60 may mean that a person has kidney disease. When the eGFR falls below 15, a person may have kidney failure. Kidney failure may require dialysis or a kidney transplant.

To diagnose the specific cause of kidney disease, a doctor may recommend other tests, such as an imaging scan of the kidneys.

Treatment for kidney disease depends on how severe the condition is. People experiencing kidney failure have kidneys that are not functioning well enough to sustain their body and filter their blood. They may need dialysis, which helps filter the blood. A kidney transplant is a longer-term solution and an alternative to dialysis.

In most cases, it is not possible to reverse damage to the kidneys. Instead, treatment focuses on maintaining a healthy lifestyle so that kidney disease does not get worse.

Some options include:

  • getting more frequent exercise
  • treating and controlling other medical conditions, such as diabetes and high blood pressure
  • quitting smoking, if applicable
  • reducing or eliminating alcohol consumption, if applicable
  • reducing protein intake
  • eating a kidney-friendly diet that is lower in sodium, potassium, and phosphorus

In some cases, a person may be able to take medication to slow the progression of kidney disease. Medication can also help with managing other conditions, such as high blood pressure.

Learn more about the best diet for healthy kidneys here.

Many of the same strategies that prevent other conditions can also lower the risk of kidney disease.

People can try the following prevention tips:

  • Eat a wide variety of healthy foods, such as whole grains, fruits, vegetables, and lean proteins. Eat under 2,300 milligrams of sodium per day.
  • Manage any underlying medical conditions, such as diabetes and high blood pressure.
  • Maintain a moderate body weight.
  • Do not smoke.
  • Do not drink alcohol to excess.
  • Monitor one’s cholesterol levels.
  • Get at least 7–8 hours of sleep at night.
  • Develop a plan for managing stress, as stress — including the stress of racism — can slowly damage the body.
  • Exercise for at least 30 minutes most days of the week.

Early stage kidney disease is a treatable medical condition. With a healthy lifestyle and quality medical care, a person can live a long and healthy life.

That said, kidney disease increases the risk of death from other conditions, including heart disease, as well as the risk of hospitalization.

African American people generally have a worse outlook with chronic kidney disease, especially in the later stages. A kidney transplant may help a person survive much longer, but a person who needs a kidney transplant may also die while waiting for one.

A 2020 study involving 422 people undergoing dialysis found that after a year, 82.3% were still alive. The average overall survival rate was about 6.79 years. Survival rates varied depending on a person’s blood work and overall health, and factors such as serum iron, protein, and calcium helped predict survival.

This suggests that a doctor may be able to more accurately estimate long-term survival based on a person’s test results.

Chronic kidney disease is a potentially fatal medical condition.

Most types of kidney disease are preventable, and, in the early stages, making lifestyle and other changes may prevent kidney disease from getting worse.

Because African American people may face diagnostic delays and other barriers to treatment, it is important for them to seek prompt medical care with a doctor who listens to them and respects their requests for testing and treatment.

Kidney disease can increase the risk of death from other conditions, but on its own, it is very treatable with the right medical care.