Addressing Health Disparities in Chronic Kidney Disease

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By  LaVarne A. Burton

All of us in the renal community are confronted daily with evidence of the health care disparities that impact people who are living with chronic kidney disease (CKD).

The statistics are familiar: CKD is our nation’s ninth leading cause of death, and by some estimates there are more than 31 million Americans who are living with CKD—the vast majority of them undiagnosed. And we know from studies in recent years that disparities in CKD are common, though we do not yet know all of the reasons. For example, while African Americans and Caucasians have been shown to develop CKD at about the same rate, African Americans are four times more likely to progress to end-stage renal disease (ESRD) than their Caucasian counterparts. African Americans comprise almost a third of the dialysis population yet make up only 13 percent of the U.S. population.

Yet disparities exist for more than genetic reasons. Access to care and cost of care are key factors that influence disparities. Lower socioeconomic status has been associated with increased risk for kidney failure. Poverty has been associated with presence of albuminuria. And research reported earlier this year at the National Kidney Foundation’s Spring Clinical Meeting found that uninsured adults at high risk of CKD were 72 percent more likely to progress to kidney failure than those with private insurance coverage.

The issue of disparities is complex, and so the solutions are necessarily multifaceted. For example, the renal community is working to encourage earlier nephrology referrals for individuals who are likely to require renal replacement therapy. Late referral has been well-established as a risk factor for mortality, and studies have found late referral to be more common among black men than among white men; more common among the uninsured; and more likely to occur among those who have severe co-morbidities. Kidney Care Partners’ PEAK campaign is encouraging a broad range of interventions to improve mortality rates for first-year dialysis patients, and a key component of PEAK is to encourage earlier nephrology referrals.

The campaign is making progress, reporting a 12.2 percent reduction in first-year mortality to-date as of June 2012.

At the American Kidney Fund, our approach is twofold: identify and educate individuals who are at high risk so we catch people further upstream, before they ever develop CKD or kidney failure; and advocate for federal policy that can help to ease the burdens faced by ESRD patients who are disproportionately members of minority groups.

Our national campaign, Pair Up: Join the Fight to Prevent Kidney Disease, is the centerpiece of our effort to identify and educate people who are at risk for CKD. Last year, we provided 27,000 free kidney screenings in 18 cities across the country. We recognize that our resources to reach people who are at risk do not come close to meeting the need, and so a core component of our Pair Up campaign is to partner with other organizations, because together, our voices have much greater impact. Since we launched Pair Up in 2011, 20 organizations have signed on as our partners—renal organizations like the American Nephrology Nurses’ Association, American Society of Nephrology, the ESRD Networks, NKDEP, and the Renal Physicians Association, and also organizations like the American Diabetes Association, the National Baptist Convention, USA, Inc., the American Society of Hypertension, and so many more, all of whom have committed to join us in spreading the word about CKD prevention.

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