What African-Americans Need to Know About Kidney Health

cover6Story by: Darwin Campbell,African-American News&Issues

HOUSTON- Did you know that African Americans are 3 times more likely to experience kidney failure? Because kidney disease often has no symptoms, it can go unnoticed until it is very advanced. Taking steps to live a healthy lifestyle can go a long way towards reducing risk, and early detection and treatment can slow or prevent the progression of kidney disease.

KIDNEY DISEASE TRAVELS BELOW RADAR

More than 40% of African Americans have at least one risk factor for the deadly disease, only 3% concerned

Even many physicians are unaware of the extent of the crisis because they continue to adhere to outdated standards of kidney function, investigators say.

These important finding comes from results of the Jackson Heart Study, reported in the American Journal of Kidney Diseases, the official journal of the National Kidney Foundation.

“Much of the problem of patient awareness is due to a lack of awareness of the medical practitioners,” lead author Dr. Michael F. Flessner said. “Most physicians were trained in an era in which serum creatinine [a measure of kidney function] was used as an absolute indicator of kidney disease.”

The National Kidney Foundation is the leading organization in the U.S. dedicated to the awareness, prevention and treatment of kidney disease for hundreds of thousands of healthcare professionals, millions of patients and their families, and tens of millions of Americans at risk.

WHY ARE KIDNEYS IMPORTANT

Most people know that a major function of the kidneys is to remove waste products and excess fluid from the body. These waste products and excess fluid are removed through the urine. The production of urine involves highly complex steps of excretion and re-absorption. This process is necessary to maintain a stable balance of body chemicals.

The critical regulation of the body’s salt, potassium and acid content is performed by the kidneys. The kidneys also produce hormones that affect the function of other organs.

Currently, early stages of kidney disease are diagnosed when protein is detected in the urine. Later stages are determined by reductions in glomerular filtration rate, a measure of how well the kidneys are filtering out waste products.

Nearly half of African Americans have at least one risk factor for kidney disease, but less than 3% say they believe kidney disease is a “top health concern,” according to research released in the American Journal of Kidney Diseases, the publication of the National Kidney Foundation.

According to the NKF, everyone who carries a risk factor for kidney disease – regardless of ethnicity – must be screened for the disease, so we can catch it at its earliest stages, when treatment is most effective.

Over time, chronic kidney disease (CKD) can progress to the point where patients need a transplant or dialysis to survive.

Every year, 30,000 African Americans advance to that stage, called end-stage renal disease (ESRD) or kidney failure. They are more than three times as likely to develop ESRD as Caucasians, and are more likely to carry the primary risk factors for CKD: diabetes, high blood pressure, and a family history of kidney failure.

African-Americans are less likely to have life-threatening complication under control, new study finds

Among people diagnosed with kidney disease and high blood pressure, African-American men are least likely to have their blood pressure under control, putting them at risk of life-threatening complications, according to a study published in the American Journal of Kidney Diseases, the official publication of the National Kidney Foundation.

The study included more than 10,000 people diagnosed with chronic kidney disease (CKD) and high blood pressure, which can worsen CKD. Some research suggests that controlling high blood pressure may be the most important step in slowing the progression of CKD.

“African-Americans with CKD progress more quickly to kidney failure, at which point they must receive a kidney transplant or regular dialysis to survive,” says lead author O. Kenrik Duru, M.D. of the David Geffen School of Medicine, University of California, Los Angeles. “These findings suggest that their higher risk of kidney failure may stem, at least in part, from higher rates of uncontrolled high blood pressure.”

Furthermore, this finding suggests a way of protecting this vulnerable group from complications. “If African-American men are more likely to develop kidney failure because they are more likely to have uncontrolled high blood pressure, treating their high blood pressure more aggressively may also protect their kidneys,” adds Allan J. Collins, MD, study co-author and past president, National Kidney Foundation.

Research has shown that African-Americans with CKD progress five times more quickly to end-stage renal disease, or kidney failure, than Caucasians. The investigators in the current report found that among people in early stages of CKD who also had high blood pressure, African-American men were least likely to have their blood pressure under control. Among people in later stages of CKD, both men and women of African descent were less likely than Caucasian men and women to have their high blood pressure under control.

“These findings propose new opportunities to eliminate health disparities in people most vulnerable to CKD,” says Dr. Collins. “Treating high blood pressure aggressively in people with CKD could protect thousands – if not millions- of people from the life-threatening complication of kidney failure.”

LOW INCOME A MAJOR FACTOR IN KIDNEY DISEASE

Black Americans who live below the poverty line feel the impact beyond basic needs such as food and shelter. Low income is more strongly associated with chronic kidney disease among African Americans than it is among whites, according to a study published in the National Kidney Foundation’s American Journal of Kidney Diseases.

African Americans already have a three to four- fold increased risk of developing kidney failure over whites, but the new study indicates that being poor may be a unique indicator of kidney disease risk for African Americans. Poverty and African Americans

“Our overarching hypothesis is that there’s something different about being poor for African Americans,” said Deidra Crews, MD, Assistant Professor of Medicine at Johns Hopkins University School of Medicine’s Division of Nephrology. “While poor whites are impacted by kidney disease as well, we assume that the cause is obesity and diabetes. Once we adjust for those conditions, the association disappears. That leads to the argument that there’s something different, un-adjustable, in terms of what it means to be poor and African American.”

The study included 22,800 black and white adults living in cities across the United States. Participants underwent extensive laboratory testing, including markers of kidney disease and answered questions about their income and health.

Key Findings 

Results showed that African Americans who had incomes of less than $20,000 had more than three times the risk of excessive protein in the urine — an indicator of chronic kidney disease– than African Americans earning more than $75,000. These findings were adjusted for age, sex, diabetes, high blood pressure and lifestyle factors such as obesity and smoking.

Those with incomes between $20,000 and $35,000 had more than double the risk of kidney damage when compared to higher income African Americans.

This trend was not seen among whites.

Importance of Screening 

“This study’s findings highlight how important it is for low income African Americans to be screened for chronic kidney disease and its risk factors. Clinicians should consider asking their patients about their socioeconomic status to help determine their likelihood of developing kidney disease,” said Thomas Manley, Director of Scientific Activities for the National Kidney Foundation.

“This information could also help clinicians advise their ‘at risk’ patients appropriately,” continued Manley. “It’s important for clinicians to recognize patients with limited resources so that they can adjust their recommendations for lifestyle modifications that can reduce risk for kidney disease. Advising low income patients to join a gym or purchase expensive, healthy foods is unlikely to be effective. Clinicians need to discuss a variety of healthier options with these patients that can be accomplished within their financial means.”

OTHER DANGERS

“The National Kidney Foundation, the American Society of Nephrology, and the National Institute of Health’s National Kidney Disease Education Program are beginning to have an impact on this lack of awareness at the practitioner level,” Dr. Flessner added. Dr. Flessner is Director of the Division of Nephrology In the Department of Medicine at the University of Mississippi Medical Center in Jackson.

Besides kidney failure, the authors point out, other serious complications of not treating chronic kidney disease at the early stages are high blood pressure and heart disease.

This study included more than 3,400 African Americans who were interviewed and underwent physical examinations, including tests of their blood and urine for evidence of kidney disease and other illnesses.

They were also asked, “Have you ever been told by a doctor or health care professional that you have kidney disease?” or if they were being treated with dialysis.

Overall, 20% of subjects were found to have chronic kidney disease, but very few of those affected were aware of that fact (fewer than 15%). Thus, for every six individuals with kidney disease, only about one person knew it.

The study confirmed that certain factors increased the likelihood of having kidney disease, such as high blood pressure, diabetes, cardiovascular disease, large waist size, older age, and being physically inactive.

“It is imperative,” the authors add, “that new approaches are implemented to increase awareness, diagnosis, and treatment – for both the health care provider and the patient.” Due to high rates of diabetes, high blood pressure and heart disease, Blacks and African Americans have an increased risk of developing kidney failure.

KNOW RISK FACTORS

African Americans need to be aware of these risk factors and visit their doctor or clinic regularly to check their blood sugar, blood pressure, urine protein and kidney function.

Blacks and African Americans suffer from kidney failure at a significantly higher rate than Caucasians – more than 3 times higher

African Americans constitute more than 32% of all patients in the U.S. receiving dialysis for kidney failure, but only represent 13% of the overall U.S. population.

Diabetes is the leading cause of kidney failure in African Americans. African Americans are twice as likely to be diagnosed with diabetes as Caucasians. Approximately 4.9 million African Americans over 20 years of age are living

KNOW RISK FACTORS

African Americans need to be aware of these risk factors and visit their doctor or clinic regularly to check their blood sugar, blood pressure, urine protein and kidney function.

Blacks and African Americans suffer from kidney failure at a significantly higher rate than Caucasians – more than 3 times higher

African Americans constitute more than 32% of all patients in the U.S. receiving dialysis for kidney failure, but only represent 13% of the overall U.S. population.

Diabetes is the leading cause of kidney failure in African Americans. African Americans are twice as likely to be diagnosed with diabetes as Caucasians. Approximately 4.9 million African Americans over 20 years of age are living with either diagnosed or undiagnosed diabetes.

Additionally, 12.6% percent of all African Americans over 20 years of age have diagnosed diabetes, compared with 7.1% of Caucasians.

The most common type of diabetes in African Americans is type 2 diabetes. The risk factors for this type of diabetes include: family history, impaired glucose tolerance, diabetes during pregnancy, hyperinsulinemia and insulin resistance, obesity and physical inactivity. African Americans with diabetes are more likely to develop complications of diabetes and to have greater disability from these complications than Caucasians. African Americans are also more likely to develop serious complications such as heart disease and strokes.

High blood pressure is the second leading cause of kidney failure among African Americans, and remains the leading cause of death due to its link with heart attacks and strokes.

The National Kidney Foundation (NKF) offers this 6-step primer for protecting health.

Know These Facts

6 Things Healthy Kidneys Do:

Regulate the body’s fluid levels

Filter wastes and toxins from the blood

Release a hormone that regulates blood pressure

Activate Vitamin D to maintain healthy bones

Release the hormone that directs production of red blood cells

Keep blood minerals in balance (sodium, phosphorus, potassium)

8 Problems CKD Can Cause:

Cardiovascular disease

Heart attack and stroke

High blood pressure

Death

Weak bones

Nerve damage (neuropathy)

Kidney failure (end-stage renal disease, or ESRD)

Anemia or low red blood cell count

Recognize Symptoms 

8 Possible Trouble Signs:

Most people with early CKD have no symptoms, which is why early testing is critical. By the time symptoms appear, CKD may be advanced, and symptoms can be misleading. Pay attention to these:

Fatigue, weakness

Difficult, painful urination

Foamy urine

Pink, dark urine (blood in urine)

Increased need to urinate

(especially at night)

Puffy eyes

Swollen face, hands, abdomen, ankles, feet

Increased thirst

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