Prevalence of Predialysis Kidney Disease in Disadvantaged Populations in Developed Countries: United States

Disparities in the incidence, risk factors, and treatment of chronic kidney disease (CKD) and end-stage renal disease are well documented, disproportionately affecting racial/ethnic minorities and persons with low socioeconomic status. The black-white disparities in the prevalence of CKD in the United States have primarily been observed in those with advanced CKD, which may be due to faster rate of progression of kidney dysfunction and an apparent survival advantage among blacks with late-stage CKD. A similar phenomenon has been observed among Hispanic patients, resulting in higher incidence and prevalence of end-stage renal disease than non-Hispanic whites. Assessment of racial disparities in CKD among other smaller minority groups is limited by the lack of adequate longitudinal data and heterogeneity of the individual population, thus further epidemiologic research is warranted. The underlying mechanisms of racial/ethnic disparities in CKD outcomes are complex and include genetic, biologic, socioeconomic, environmental, psychosocial, and cultural factors, as well as patient, provider, and health care system factors that affect access and quality of care.