woman sitting in hospital bed

Racial Disparities in Kidney Disease and Treatment

Blacks are more likely than whites to suffer from the most advanced stage of the illness.

By Julie Scharper

For patients with kidney failure, a transplant is the optimal treatment to improve quality of life and life expectancy.

Yet, while Black people have three times the rate of end-stage kidney disease than whites, they are less likely to receive a kidney transplant—especially from a live donor, which yields the best health outcomes. 

“There are significant disparities in who gets access to a transplant at every single level, starting with who has access to a nephrologist, or kidney specialist, prior to ending up with complete kidney failure,” says Tanjala Purnell, PhD ’12, MPH, an associate director of the Johns Hopkins Center for Health Equity and the Johns Hopkins Urban Health Institute. “The timing is important in terms of being referred for care and making it through the very lengthy clinical evaluation process to potentially get on a waiting list for a kidney.”  

Instead of a transplant, Black people are more likely to remain on prolonged dialysis, which can lead to many painful and dangerous complications. 

It doesn’t have to be this way, says Purnell, assistant professor in Epidemiology. When kidney disease is caught early, through routine screening and primary care visits, patients have a better chance of reducing disease progression and other complications. 

But deeply entrenched inequities in income, housing, education, employment, and other areas, contribute to the disproportionate burden of kidney failure borne by Black Americans. 

Black patients who live in low-income communities may have less access to healthy food sources, limiting their ability to follow a healthy diet, which, in turn, can help prevent diabetes and hypertension—leading risk factors for kidney failure. 

And although Black people suffer from higher rates of these chronic conditions than white people, they may face multiple barriers to accessing appropriate medical care, including a lack of private insurance and microaggressions from health workers, Purnell says. Many Black patients also fear the medical system due to a long history of racist practices.

Purnell published a national registry study in JAMA Network Open this summer showing that racial inequities in nephrology care remained unchanged from 2005 to 2015. 

Through her work with the Center for Health Equity and the Urban Health Institute, she encourages health professionals to work collaboratively with the communities they serve to build collective capacity for achieving health equity . 

“We need to think holistically about the role of structural racism and social, political, and economic barriers and how these collectively lead us to many of the observed differences in a lot of our [health] outcomes across the board,” Purnell says. 

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