1. What is the incidence of end-stage kidney disease (ESKD) in african americans?

African Americans represent about 13% of the United States population but account for more than one-third of the ESKD population. African American adults are almost four times as likely as non-Hispanic Caucasians to develop ESKD. Among men aged 20 to 39, African Americans are approximately 15 times more likely to develop ESKD secondary to hypertension than age-matched Caucasian men.

2. What are the risk factors for eskd among african americans?

Many biologic and socioeconomic variables might influence the onset and progression of kidney disease among African Americans. Hypertension, diabetes, and obesity are associated with increased risk for ESKD and are more highly prevalent in African Americans. High blood pressure (BP) accounts for nearly one-third, and diabetes accounts for nearly half, of new cases of ESKD among this population group. The social position of African Americans in the United States and the lingering effects of legalized residential segregation place most African Americans in neighborhoods with poor health assets. They are more likely to suffer from low socioeconomic status, being uninsured or under-insured, and have low health literacy. These factors and others, such as a lack of awareness of chronic kidney disease (CKD) risk factors, contribute to the increased risk of ESKD among this group. These factors may adversely affect BP and blood glucose control in patients with hypertension and diabetes, respectively, accelerating the onset and progression of kidney disease.

Biological factors that originated as a result of shared evolutionary ancestry, such as variant APOL1 gene polymorphisms, which emerged in West Africa to protect against trypanosomiasis, and the presence of two risk alleles (present in approximately 12% of African Americans) is associated with an increased risk of developing ESKD. Other biologic markers, such as certain polymorphisms of the GSTM1 gene, an oxidative stress regulator, are associated with a reduced risk of CKD and are more prevalent among African Americans. Thus, the role of social determinants of health juxtaposed with an array of risk and resilience genes may conspire differently in varying settings to influence CKD and ESKD in African Americans.

3. What is the role of diabetes in kidney disease among african american patients?

High BP and diabetes account for nearly three-quarters of the new cases of ESKD. Diabetes alone accounts for nearly half of new ESKD cases. Increased rates of poor diabetes control among African Americans accelerate diabetes-related kidney injury. Increased rates of hypertension and poor BP control further contribute to the high prevalence of kidney disease among this patient group with diabetes.

4. What are some of the key lifestyle changes to optimize BP and blood sugar control and preserve kidney function in african american patients?

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  Healthy diet

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  Low fat, low sodium, high potassium, and adequate calcium intake.

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  Regular physical activity

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  Increase physical activity as part of the daily routine by undertaking an enjoyable physical activity for 30 to 45 minutes per day for 3 to 5 days per week.

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  Weight maintenance

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  Monitor body weight and maintain a healthy body mass index.

  
  
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  Maintain weight by making permanent changes in the daily diet.

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  Stress reduction

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  Develop coping skills for specific stressors in work and/or home environment with meditation, relaxation, yoga, biofeedback, etc.

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  Smoking cessation

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  Ensure a smoke-free environment.

5. What are some of the key approaches to achieve healthy dietary changes in african american patients?

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  Recommend nutritional substitutions with foods that an individual will likely eat

  
  
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  Eat more broiled (grilled) and steamed foods

  
  
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  Eat more grains, fresh fruits, and vegetables

  
  
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  Eat fewer fats and use healthier fats, such as olive oil

  
  
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  Eat fewer processed foods, fast foods, and fried foods

  
  
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  Read labels and pay attention to the sodium, potassium, and fat content of foods

  
  
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  Do not season foods with smoked meats, such as bacon and ham hocks

  
  
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  If lactose intolerant, try lactose-free milk or yogurt, or drink calcium-fortified juices or soy milk

  
  
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  Limit alcohol consumption to <2 beers, 1 glass of wine, or 1 shot of hard liquor per day

  
  
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  Limit the intake of sugar-sweetened beverages and juices

6. When should antihypertensive drug therapy be initiated in african american patients with kidney disease?

Pharmacotherapy should be initiated promptly for persistent elevation in BP in spite of the therapeutic lifestyle changes. Many guidelines recommend both pharmacotherapy and therapeutic lifestyle intervention if BP is greater than 140/100 mm Hg. If below that level, a 3-month trial of therapeutic lifestyle intervention to achieve a BP less than 140/90 mm Hg—and if that is not achieved then pharmacotherapy—should be initiated. In the presence of proteinuria and/or comorbidities, a more aggressive approach with targeting a BP below 130/80 mm Hg is recommended by some guidelines. This approach would be supported as safe and likely effective by the findings of the Systolic Blood Pressure Intervention Trial (SPRINT) that demonstrated improved outcomes in nondiabetic patients with hypertension with an even lower systolic BP target of less than 120 mm Hg, including the subset with reduced estimated glomerular filtration rate (eGFR).

7. What is the relationship between BP level and kidney disease among african american patients?

African Americans suffer from one of highest prevalence rates of high BP in the world. High BP predisposes to kidney disease and kidney disease predisposes to high BP. This vicious cycle among African Americans, in part, accounts for the substantially higher incidence of hypertension-related ESKD compared to non-Hispanic Whites. Aggressive and appropriate screening for elevated BP and kidney disease among African Americans will minimize the role of this vicious cycle in the rapid progression of kidney disease.