Thursday, March 08, 2018

African-Americans Face Higher Rates of Kidney Disease as Experts Look at Diet, Stress, Socioeconomic Factors
Dr. Deidra Crews speaks with her patient Keith White, who just had dialysis at Fresenius Kidney Care. African-Americans have three times the rates of kidney disease than whites. (Algerina Perna / Baltimore Sun)

Andrea K. McDaniels
The Baltimore Sun

For the past 13 years Keith White has scheduled his life around his bad kidneys and dialysis treatments.

The retired Maryland Transit Administration police officer switched to night shift to fit in the three-hour treatments and still work. Family vacations mean making sure a dialysis center is nearby. If he misses his thrice-weekly treatments, his body will fill with toxins that will kill him.

“You have to accept it because if you don’t get it you wont be here on this earth,” the 57-year-old White said about life with dialysis.

White is one of the tens of millions of African-Americans disproportionately affected by chronic kidney disease. African-Americans are three times more likely than whites to have the disease. While they make up 13.2 percent of the U.S. population, they account for more than 35 percent of those on dialysis for kidney failure.

Earlier this week, Bill Cosby’s daughter Ensa Cosby died from renal disease, the last stage of chronic kidney disease, when the kidneys stop filtering waste and excess fluid from the blood. Dangerous levels of electrolytes and waste then build up in the body.

There are many reasons African-Americans may be more prone to kidney disease, research has found. Diabetes and heart disease are the two most common causes of kidney disease in all races and African-Americans have higher rates of these diseases. Scientists also have identified genetic markers linked to kidney disease that are more common in African-Americans. Poverty and access to medical care may play a role, too.

Dr. Deidra Crews, an associate professor of medicine at Johns Hopkins School of Medicine who studies the disparity, is looking at whether improving eating habits can help address the differences.

People who eat diets rich in meat, cheese, eggs and other animal-based foods tend to have a higher acid load in their bodies that some research has shown can injure the kidney. Fruits and vegetables have more alkaline qualities.

Crews is a principal investigator of a study that is trying to determine if eating meals high in fruits, vegetables, nuts, beans and lean meats can can protect the kidneys and reduce kidney damage. As part of the study, called the 5+ Nuts & Beans for Kidneys, participants will get free healthy groceries from ShopRite supermarket.

The study will target low-income East Baltimore residents who have high blood pressure and early kidney damage. They will meet regularly with coaches and clinicians to discuss how to stick to the healthy diet.

“People who live in poverty have less healthy dietary patterns and their dietary patterns could influence the rate of kidney disease,” said Crews, who is also the medical school’s associate vice chair for diversity and inclusion.

Crews also studies what role socioeconomic status plays in the higher rates of kidney disease in African-Americans. Having a lower socioeconomic status is more strongly associated with kidney disease even among African-Americans. High levels of stress — some of it caused by discrimination — among low-income African Americans also may contribute to kidney disease.

The National Kidney Foundation created a web portal several years ago devoted to educating people about the risks of kidney disease in African-Americans. One focus is trying to diagnose people earlier. Kidney disease is sometimes called the silent epidemic because there are no symptoms until the later stages.

The foundation has pushed to include the blood and urine tests used to diagnose kidney disease as part of routine blood work.

“We are trying to catch people before they get to kidney failure, before they need a transplant or dialysis,” said Jessica Quintilian, an executive associate director at the National Kidney Foundation Serving Maryland and Delaware.

Other groups have looked at ways to improve the lives of people with kidney disease once it has reached the advanced stages.

The NAACP has a campaign that not only raises awareness of the disease but looks at ways to make dialysis more bearable and less disruptive for patients. They are working with Alliance for Home Dialysis to help more African-Americans get treatment in their homes. This gives people more flexibility for when they get dialysis and eliminates the need to drive to a center.

There also are efforts to increase the number of African-Americans who receive live kidney transplants so they no longer need dialysis. Organ matches can be more difficult for African-Americans in part because they donate at lower rates. Transplants can work between races, but the donor must have a similar genetic makeup for there to be a match. This happens more readily within the same race.

African-Americans may not donate for a variety of reasons. They may not be able to take the time off from work that the procedure requires, or they may not trust the health system. And even those who want to donate may have health problems that make it dangerous for them to get such a complex surgery.

In 2015, only 17 percent of African-Americans waiting on a kidney were able to get a transplant, according to the U.S. Department of Health and Human Services Office of Minority Health. Of white Americans waiting for a transplant, 31 percent, were able to get a new kidney.

Like that of many African-Americans, White’s kidney disease was in an advanced stage when he was diagnosed. He began getting dialysis almost immediately after getting the news.

White had diabetes and heart disease and had been warned those conditions could lead to to kidney failure. He also ate an unhealthy diet that included a lot of fast food late at night. His job as a police officer was stressful.

Still, his diagnosis took him by surprise. At the time, he was just 43 years old.

He has tried not to let the disease keep him from enjoying life. He had young children who wanted to vacation in Myrtle Beach. He didn’t want to take that away from them.

“i just had to go ahead and try to maintain my lifestyle as much as I could,” he said.

The disease prompted White to eat healthier and exercise more. He has lost weight and no longer takes medication for diabetes and high blood pressure. He encourages his kids to eat healthy.

“I tell them, you don’t want to end up in my situation,” he said.

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