Racial Differences in Kidney Disease and End-Stage Kidney Disease in the USA

Despite the near-universal access to treatment for end-stage renal disease (ESRD) under the federally funded Medicare program, ESRD constitutes a major health disparity among racial and ethnic minority groups in the United States, particularly among blacks. Racial and ethnic minority patients have an excess risk of ESRD attributed to diabetes or hypertension, in part due to increased susceptibility to accelerated progression of chronic kidney disease in addition to other environmental, sociocultural, and behavioral factors. Furthermore, racial and ethnic disparities with respect to the treatment of ESRD, to include kidney transplantation, are well documented. Despite having poor intermediate health outcomes, however, minority groups with ESRD on dialysis survive longer than non-Hispanic whites, the so-called survival paradox. Health inequities among minority groups with ESRD warrant a research imperative to better understand many of the genetic, biological, environmental, sociocultural, and health care system-level factors that could ultimately lead to improved outcomes for all patients with ESRD.