Why Kidney Disease Affects Black Communities More Severely And Why It is Not Just Genetics
When I was just a teenager, I got my first true look at how renal illness can destroy families. The diagnosis of kidney failure was made for an older neighbor who was like a grandfather to everyone. Shortly after, a cousin of mine who had children my age also began dialysis. She eventually got a kidney transplant. You will hear variations of this story repeatedly in many African American households if you ask around.
Not everyone is affected by kidney disease. Black Americans are disproportionately affected, and this is nothing new. But why? They are systemic, multi-layered, and, to be honest, unsettling.
The data was late, but it was not false.
The glaring racial differences in kidney disease were not acknowledged in medical literature until 1982. According to a seminal research in the New England Journal of Medicine, Black people in Jefferson County, Alabama, had an 18-fold higher risk of end-stage renal failure due to hypertension than white people.
However, clinicians on the ground had previously detected it long before it was published in publications. The dialysis clinics in Birmingham, where I started my nephrology training in 1993, told their own tale. Black and Brown patients, including grandparents, grandchildren, and siblings, sometimes from the same family, made up the majority of them. It went beyond anecdotal evidence. There was no denying it.
It is Not Just About High Blood Pressure and Diabetes
For many years, African Americans were blamed by the mainstream narrative for having greater incidences of diabetes and hypertension. You had a neat explanation when you combined that with late diagnosis, underfunded clinics, and restricted access to health insurance.
The problem is that the gaps persisted even after we concentrated on diagnosing and treating those illnesses. The U.S. Renal Data System shows that kidney failure still affects Black Americans at a rate that is more than three times higher than that of white Americans—5,855 cases per million as opposed to 1,704 instances. The numbers did not add up.
The APOL1 Gene: Part of the Puzzle, Not the Whole Piece
Then, in 2010, scientists discovered an intriguing genetic twist: variations in the APOL1 gene, which are primarily present in individuals of African ancestry, may raise the risk of kidney disease, particularly if two copies are inherited.
It was a seismic discovery. It clarified why certain Black people with COVID-19 or HIV were more susceptible to kidney damage than others. Additionally, APOL1 may have initially offered a survival advantage by protecting against the lethal parasite disease known as African sleeping sickness, similar to the sickle cell gene.
To be clear, however, genetics does not explain everything.
Even for those who do, the environment stress, food hardship, and limited access to healthcare is what makes those genetic "matches" into fires.
It is Also About Systems Designed to Failing Some and Helping Others
One cannot create health in a vacuum. Our upbringing, the air we breathe, the schools we go to, and the hospitals we can (or cannot) access all contribute to its construction or destruction.
The United States is a country of invisible borders, according to social justice activist and former nurse Reverend Traci Blackmon. On one side are areas that are primarily Black, frequently food deserts, have dilapidated schools, low property prices, and limited access to economic opportunities. Conversely, wealthy communities that enjoy all the advantages of structural privilege. These divisions did not just happen. They were designed by Jim Crow laws, redlining, and other practices that produced "separate and unequal" institutions.
Like many other chronic illnesses, kidney disease is a result of the cumulative effects of living with various problems. It is a rigged game's body maintaining score.
The Solution? It Outweighs Medicine
Indeed, improved access to nephrology care is necessary. Yes, patients should be aware of their eGFR, which is a measure of how well their kidneys filter blood. Indeed, receiving a transplant evaluation early on can change a person's life.
However, we also require something more significant: the dismantling of the structures that initially give rise to these disparities. This entails addressing environmental racism, changing housing regulations, repairing damaged educational institutions, and ensuring that healthcare is genuinely equitable—not just accessible on paper, but also accessible in practice.
It entails giving patients the confidence to inquire, push for recommendations, and comprehend—rather than merely accept their condition. When someone say, "I do not feel heard," it also signifies that you are paying attention.
The Bottom Line
In addition to reflecting biology, kidney disease also reflects society. The deeper roots are entangled in centuries of inequality, even though APOL1 provided us with a portion of the solution
Genetic research is not enough to enhance results. Policy reform, community-centered care, and an openness to confronting the unsettling realities of race, power, and health in America are all necessary.
Because the issue is not limited to their physical health when entire populations are afflicted by the same illness. The blueprint mentions it.
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