By Keith Norris, MD

Chronic kidney disease (CKD) has been estimated to affect nearly 20 million Americans. The increase of CKD is now reaching epidemic proportions. The rates are even higher among racial and ethnic minorities. CKD can progress to end-stage renal disease (ESRD) and the need for dialysis or a kidney transplant.

Minorities in the United States are almost two to four times more likely than non-minorities to reach ESRD (Table 1). The main causes of kidney disease in the U.S. are diabetes mellitus and hypertension. Many people know these conditions by the names diabetes and high blood pressure (Table 2). Both diabetes and high blood pressure are more common among minorities. Even with the same medical care, minorities seem more likely to get kidney disease. Many factors may add to the chance of getting kidney disease, including hereditary or genetic factors, the environment or how well diabetes and high blood pressure are controlled. CKD, diabetes and high blood pressure can cause many problems. These include disability, high healthcare costs and poor quality of life. As kidney disease worsens, the chance of heart disease or ESRD is higher. If a person is on dialysis or has a transplant, they should get their heart checked regularly.

Table 1: Odds (% greater chance) of a minority needing a dialysis or a kidney transplant for end-stage renal disease (ESRD) in the United States.

*From the United States Renal Data System (USRDS) 2003

How can we reduce the high rate of kidney disease among minorities? Experts have decided to focus on education, prevention and early treatment. The key to education is to make information readable and sensitive to the culture and background of people. The key to prevention and early treatment is to screen and identify persons at risk.

About Diabetes & High Blood Pressure

Diabetes and high blood pressure cause 75 percent of the cases of ESRD. Programs to educate people about these two disorders are important. If new cases of diabetes and high blood pressure can be reduced, then the number of people with kidney disease also will decrease. Diet, exercise and taking medication (if needed) can make a big difference. Diet and exercise are also important to improve the quality of life and reduce heart disease.

Education

Information about kidney disease, diabetes and high blood pressure is available to patients. Many groups (professional organizations and government agencies) provide these materials. America’s average reading level is the seventh or eighth grade. The reading level of most healthcare professionals is above the twelfth grade. As health professionals write much of the educational material, it is important that it be presented in a way that everyone can understand. Many minorities have even lower reading levels than the average person does. One reason may be that English is a second language for many minorities. Therefore, health information should be written at or below the seventh or eighth grade level and should be sensitive to minority cultures.

Many patients have cultural differences with their healthcare team. Education for the patients, doctors, nurses and staff can also help reduce these differences. This is very important for dialysis and transplant patients to help patients feel comfortable with their kidney team. Then, they are more likely to listen to the advice and treatment plan. Increasing the number of minority doctors and nurses will also help to reduce cultural barriers.

Table 2: Other names for diabetes and high blood pressure.

Screening

Starting a screening program in the minority community is not easy. Many minorities have little to no access to healthcare and are less likely to trust doctors and hospitals. Some minority cultures use a local healer (e.g. curandero or herbalist), while others look to the church for advice. Screening programs that understand these differences are more likely to succeed. Many education and screening programs now work with churches and other community groups to reach minority populations.

Several national organizations have kidney disease education programs (Table 3). These programs aim to help more people receive treatment to slow the progression of or stop their kidney disease. These education and screening programs may help reduce kidney disease in our nation and specifically the huge problem of kidney disease in minority communities. Early screening and education teaches a person more about kidney disease, ways to halt the progression and healthy living tips. If a person needs dialysis or a transplant, they are healthier and live longer with more education. Patients on dialysis or with a transplant can encourage family members to be checked for kidney disease, since family history is a risk factor.

Table 3: Key screening and education programs for people at risk for kidney disease or with early stages of kidney disease.

Conclusion

Kidney disease is a big problem. More and more people are getting kidney disease, especially minorities. Diabetes and high blood pressure are the main causes of kidney disease. Diet, exercise and health insurance can help reduce kidney disease. Educating people about kidney disease, diabetes and high blood pressure is especially necessary. So is finding out who has kidney disease early on, so they can be treated. Several national groups that help fight kidney disease are doing this. The new education and screening programs are doing a better job to reach minorities. In the future, these programs will help reduce the number of people suffering from kidney disease.

Keith Norris, MD, is a faculty member in the Department of Internal Medicine and the Associate Dean for Research at Charles R. Drew University in Los Angeles. Dr. Norris is also a member of the AAKP Medical Advisory Board.

This article originally appeared in the March 2004 issue of aakpRENALIFE, Vol. 19, No. 5.

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