Ethical implications of ethnic disparities in chronic kidney disease and kidney transplantation.
Chronic kidney disease (CKD) is a major epidemic in underserved and minority populations largely due to excess rates of hypertensive and diabetic kidney disease. Multiple complex socioeconomic barriers to early diagnosis and optimal therapies as well as delayed referral for kidney transplantation have created disparities in CKD care provided to ethnic minorities. Disparities exist in wait list time and kidney transplant rates for Native Americans and blacks, independent of insurance status. Moreover, independent of genetic matching, long-term transplant outcomes in blacks remain significantly lower than all other ethnic groups, suggesting that poorly understood social factors contribute to these survival differences. The existence of these disparities raises ethical concerns of equity and social justice in terms of the allocation of scarce resources. Although current changes in allocation policies will improve some disparities, more efforts are ultimately needed to improve access to care and the overall health and survival for all individuals at risk for CKD, independent of their race, ethnicity, or socioeconomic status.
Isaacs
Ross
R
Division of Nephrology, University of Virginia Health System, Box 800133, Charlottesville, VA 22908, USA. rbi9u@virginia.edu
D001741:Black or African American / Q000706:statistics & numerical data; D003920:Diabetes Mellitus / Q000453:epidemiology; D006297:Health Services Accessibility; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007198:Indians, North American / Q000706:statistics & numerical data; D007674:Kidney Diseases / Q000208:ethnology; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000208:ethnology* / Q000601:surgery*; D016030:Kidney Transplantation / Q000941:ethics* / Q000208:ethnology*; D008913:Minority Groups; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology / Q000208:ethnology