By Ebony JJ Curry | Michigan Chronicle | Word In Black
This post was originally published on Michigan Chronicle
(WIB) – Kidney disease, a shadowed giant within Black America, has long lurked in the background of public health discussions, its significance often underestimated in the broader narrative of racial health disparities. But for those in the Black community, it’s neither unfamiliar nor taboo — it’s a reality that touches many, either personally or through someone they know.
In the United States, African Americans are three times more likely to experience kidney failure than their white counterparts. This staggering statistic isn’t just a number; it represents a myriad of stories, struggles, and resilience. The roots of this disparity are deep, intertwined with higher rates of diabetes and hypertension within the Black community, conditions that are leading contributors to kidney disease.
Diana Moore, a 63-year-old Black woman and now widow, reflects on her life since her husband passed away from kidney failure. After years of managing his condition with dialysis, his health progressively worsened until he succumbed to the disease last April. “Those years on dialysis were tough, not just for him, but for both of us,” Diana shares. Her story is a relatable account of the daily challenges faced by families dealing with this chronic illness — sleepless nights, insurmountable visits to dialysis, and the true battle of attempting to outrun the disease.
Their life together was deeply affected by his kidney disease. “It was a constant presence in our lives, from the frequent hospital visits to the way it slowly took a toll on his health,” she remembers. The couple had no children, and this shared struggle forged an even stronger bond between them. “We relied heavily on each other. His strength during those times was inspiring, but watching him suffer was incredibly hard,” Diana expressed.
Now, Diana focuses on raising awareness about kidney disease, especially among Black communities. “I’ve seen firsthand what this illness can do. If my story can encourage even one person to get a health check or learn more about kidney disease, then it’s worth it,” she says. Diana’s experience, while unique in its details, echoes the challenges many faces when dealing with chronic illnesses – a reality that the Black community knows all too well.
But beyond the physical manifestations—beyond the treatments, the dialysis, and the medical statistics—lies an often-overlooked aspect: the mental and emotional toll. For those grappling with kidney disease, the journey isn’t solely about managing a physical condition; it’s a constant mental battle. Anxiety and depression frequently accompany the diagnosis, fueled by the chronic nature of the disease and the intensity of its treatment.
This condition extends its impact beyond the individual to touch families and communities. The ripple effect is profound, affecting caregivers, loved ones, and the broader community. Family members often find themselves thrust into the role of caregivers, a transition that brings its own set of challenges and emotional burdens.
In Michigan and Detroit, the narrative is no different. These areas, reflective of the broader national trend, see a significant number of African American residents battling kidney disease. These communities serve as microcosms of the larger issue, highlighting the need for targeted awareness, education, and intervention strategies that address the specific needs of the Black population.
Unsurprisingly, it is decades of systemic injustice in the urban corners of the United States, specifically “redlining” — discriminatory policies that led to significant disinvestment in minority communities — have a lingering and detrimental impact on the health of Black Americans in all areas ranging from asthma to cancer but particularly, in the context of kidney disease.
A recent study conducted by the Boston University School of Public Health (BUSPH) has drawn a direct line between these historical injustices and the current disproportionate rates of kidney failure among Black adults. The research suggests that the long-term effects of disinvestment in historically redlined neighborhoods are likely contributing factors to the high incidence of kidney failure in these communities.
Dr. Kevin Nguyen, the study’s lead author and an assistant professor of health law, policy & management at BUSPH, articulates the connection between historical policies and present-day health disparities. “Kidney failure disproportionately affects racial and ethnic minoritized populations, particularly Black individuals, and there is robust evidence linking neighborhood conditions to disparities in kidney disease,” he explains. Dr. Nguyen further elaborates on the potential implications of this legacy: “It is therefore possible that in present-day neighborhoods, historical redlining could create conditions such as exposure to pollution, food insecurity, and worse health care, which have been shown to contribute to inequitable rates of kidney failure incidence.” This study sheds light on how discriminatory past practices continue to influence the health outcomes of Black Americans today in an alarming yet expectedly way, particularly in the realm of chronic conditions like kidney disease.
Black Americans, who are at a 2- to 4-fold higher risk of developing kidney failure compared to White Americans, have consistently been less likely to receive transplants over the past 30 years.
Another setback? Clinical biases and lack of awareness. Kidney transplants, particularly those from living donors, offer significantly better outcomes for patients with kidney failure. Despite this, Black Americans, who are at a 2- to 4-fold higher risk of developing kidney failure compared to White Americans, have consistently been less likely to receive transplants over the past 30 years. Addressing this stark disparity requires tackling its multilevel causes, which include a range of patient social contexts such as lack of insurance, limited knowledge, and financial or logistical challenges, all deeply rooted in social policies that reflect structural racism.
Betty Paret, Regional Vice President of Operations for Fresenius Kidney Care, speaks about the critical issues surrounding transplant accessibility for Black patients with kidney disease. She highlights the stark disparity in access to kidney transplants, echoing, “African Americans are 2-4 times more likely to develop kidney failure than white individuals yet are less likely to receive kidney transplant.” She further identifies the underlying causes, explaining, “Factors associated with racial transplant inequities from a social context are lack of insurance, poor knowledge financial and logistical barriers.”
However, the medical community itself has played a role in perpetuating these inequities. Delayed referrals for kidney care and transplant evaluation disproportionately affect Black patients; this is a reality that Mrs. Moore encountered. Unsettlingly, her husband was on the transplant list for 8 years before his passing. Such delays are often linked to implicit or explicit biases among clinicians, including misconceptions about the suitability or effectiveness of transplants for Black patients, or misinformed beliefs about the causes or extent of these disparities. Additionally, the potential impact of clinical guidelines, including those that use racialized estimates of kidney function, on referral and evaluation practices for transplants has been a concern, as they may systematically contribute to these racial disparities in kidney transplant accessibility.
Paret says Fresenius Kidney Care is actively working to address these disparities, “Fresenius Kidney Care is committed to overcoming the social inequities and removing the barriers between dialysis clinics and transplant centers,” said Paret. The organization’s approach includes ensuring that patients receive comprehensive transplant education, as mandated in the ESRD conditions for coverage. “Unfortunately, there is low public awareness about kidney disease and its risk factors. Education is then a key element to creating that awareness. Optimally the goal of education is slowing kidney function loss and delay dialysis. Fresenius offers treatment option education in the community, offices of primary care physicians and partners with the National Kidney Foundation. At the heart of the partnership with the National Kidney foundation is a shared commitment to raising awareness and supporting people living with kidney disease.”
Linda Smith-Wheelock, President & CEO of the National Kidney Foundation of Michigan shared, “The social determinants of health – the conditions in which people are born, grow, live, work and age – disproportionately impact Michigan’s Black communities. Early childhood development, income, employment, education, housing, racism are all key determinants.” Additionally, she emphasizes NFKD’s commitment to addressing kidney disease disparities in the Black community. She highlights two significant initiatives: the recently concluded 5-year CDC Racial and Ethnic approaches to Community Health (REACH) project, focusing on areas with high African American populations most notably, Wayne County amongst others, and the Morris Hood III Chronic Kidney Disease and COVID-19 Complications Prevention Initiative. This latter initiative, named after a kidney transplant recipient and legislator, aims to transform kidney care and prevention, especially amidst COVID-19 challenges. “He dedicated his time to educating others, particularly in the Black community about CKD prevention and early detection,” she said. “This initiative is dedicated to transforming kidney care and CKD prevention across the state.”
Smith-Wheelock also notes the foundation’s efforts in supporting kidney transplant accessibility for Black Michiganders, collaborating with organizations like the Detroit Minority Organ Tissue Transplant Education Program. On November 8, 2023, the Michigan Legislature passed the Michigan Donor Protection act. The Living Donor Protection Act prevents and safeguards living organ donors from insurance discrimination. Additionally, she underscores the NKFM’s advocacy role, promoting the MDPA, “Michigan is now the 32nd state in the United States to enact such crucial protections for living organ donors, recognizing the importance of removing barriers to donation and ensuring access to life-saving transplants.”
Furthermore, the complexity of addressing kidney disease in Black America is evident. It’s a condition that transcends the realm of physical health, intertwining with societal and mental health issues. This multifaceted challenge provokes thought-provoking questions: How can healthcare systems better meet the unique needs of the African American community? What role do mental health and community support play in managing this chronic illness? How can awareness be raised effectively within these communities to prompt earlier detection and treatment? As these questions linger, they leave the community pondering the depth of the issue, encouraging a broader dissemination of information and a heightened awareness of the silent yet pervasive reality of kidney disease that has claimed Black America.