Kidney Disease

What is kidney disease?

Chronic kidney disease (CKD) signifies that an individual’s kidneys are damaged and losing their ability to maintain health by filtering blood. In the early stages of the disease, most sufferers do not exhibit symptoms. However, as the kidney disease progresses, wastes can accumulate in the blood, causing feelings of sickness. The individual may develop other issues, such as high blood pressure, anemia, weak bones, poor nutritional health, and nerve damage. Given the vital role kidneys play in numerous bodily functions, kidney disease also heightens the risk of heart and blood vessel disease. While these problems may develop slowly and without symptoms, they can lead in kidney failure, which can emerge unexpectedly. Once kidney failure occurs, dialysis or a kidney transplant becomes necessary for survival. Kidney failure is also referred to as kidney failure with replacement therapy (KFRT).

What causes kidney disease?

These two conditions were the primary diagnosis in 76% of kidney failure cases between 2015-2017: 47% of new KFRT patients had a primary diagnosis of diabetes, the leading cause of KFRT, while 29% of new KFRT patients had a primary diagnosis of hypertension, the second leading cause of KFRT.

Other conditions that can lead to KFRT are glomerulonephritis (diseases that damage the kidney’s filtering units), which is the third most common type of kidney disease; inherited diseases, such as polycystic kidney disease; malformations at birth that occur as a fetus develops; lupus and other immune diseases; obstructions such as kidney stones or an enlarged prostate; and repeated urinary tract infections, which can also lead to kidney infections and can cause long-term damage to the kidneys.

People with kidney disease are at greater risk for cardiovascular disease and death at all stages of kidney disease. Kidney disease and heart disease are linked and have common risk factors, such as diabetes and hypertension. Each condition can lead to or worsen the other.

Who is risk for kidney disease?

  • 1 in 3 adults in the U.S. is at risk for kidney disease. Some demographic groups are at higher risk. 
  • Risk factors for kidney disease include diabetes; high blood pressure; family history of kidney failure; age 60 or older; obesity; heart disease; past damage to kidneys; and being in minority populations that have high rates of diabetes or high blood pressure, such as Black/African Americans, Hispanics or Latinos, Asian Americans or Pacific Islanders, and American Indians or Alaska Natives (Note: current CDC/ NHANES demographic terminology.).

What’s behind racial disparities in kidney disease?

  • A breakdown of kidney disease rates within demographic categories of the general population of the United States for 2015—2018 (USRDS, Prevalence of CKD in U.S. adults within age, sex, race/ethnicity, & risk factor categories) showed: 16.0% Non-Hispanic Black/African American; 15.7% Non-Hispanic White; 11.9% Hispanic or Latino (2018).
  • Among Medicare FFS (fee-for-service) beneficiaries, kidney disease is highest among Blacks/African Americans (33%), followed by American Indians or Alaska Natives (30%), Hispanics or Latinos (28%), and Asian Americans or Pacific Islanders (26%). White (23%) beneficiaries had the lowest percentages of kidney disease (2018).
  • Non-Hispanic Black/African-American and Hispanic or Latino people experience a more rapid decline of kidney function than non-Hispanic Whites. Minority communities, in general, are at increased risk of progressing from CKD to KFRT and of progressing more rapidly.
  • Black/African American people are more than four times as likely as White people to develop kidney failure. Black/African American people are 13% of the U.S. population while representing 35% of those with kidney failure.
  • Black/African-American race is also associated with an increased risk for acute kidney injury (AKI).
  • Black/African Americans also suffer higher rates of comorbid conditions, such as diabetes and high blood pressure, resulting in higher rates of fair/poor health (age 18+, 22% Black/African Americans vs. 16% Whites).
  • Compared to non-Hispanics, Hispanics or Latinos are almost 33% (1.3 times) more likely to receive a diagnosis of kidney failure.
  • Native Hawaiians, Pacific Islanders, American Indians, and Alaska Natives also have a higher prevalence of kidney disease than Whites.
  • There are disparities in the quality of primary care for patients of different racial, ethnic, and socioeconomic groups who have kidney disease and kidney disease risk factors. These disparities are related to patient, clinician, clinical, and systemic factors. Patients receiving dialysis in areas with populations that are largely Black/African American, low-income, or of lower educational attainment are less likely to have received pre-dialysis care from a nephrologist. One study found that 52% of Hispanic or Latino patients on hemodialysis had not received pre-dialysis care from a nephrologist, compared to 44% of non-Hispanic patients.
  • Black/African Americans and Hispanics or Latinos are also less likely to be treated with kidney transplantation than Whites.
  • On average, Black/African-American transplant candidates wait longer than White transplant candidates for kidney, heart, and lung transplants.
  • In 2018, 57% of White patients with KFRT received in-center hemodialysis versus 72% of Black/African- American patients. This may reflect fewer Black/African-American patients utilizing home dialysis options.

What is end-stage renal disease (ESRD)?

Kidney failure, also called end-stage renal disease (ESRD) or end-stage kidney disease (ESKD), is the fifth and last stage of chronic kidney disease (CKD). Kidney failure cannot be reversed and is life-threatening if left untreated. However, dialysis or a kidney transplant can help you live for many more years.

For more information bout kidney failure, visit American Kidney Fund for more information.

Information on this page retrieved from National Kidney Foundation and American Kidney Fund