title: Hemodialysis Disparities in African Americans: The Deeply Integrated Concept of Race in the Social Fabric of Our Society.
abstract: End-stage renal disease (ESRD) is one of the starkest examples of racial/ethnic disparities in health. Racial/ethnic minorities are 1.5 to nearly 4 times more likely than their non-Hispanic White counterparts to require renal replacement therapy (RRT), with African Americans suffering from the highest rates of ESRD. Despite improvements over the last 25 years, substantial racial differences are persistent in dialysis quality measures such as RRT modality options, dialysis adequacy, anemia, mineral and bone disease, vascular access, and pre-ESRD care. This report will outline the current status of racial disparities in key ESRD quality measures and explore the impact of race. While the term race represents a social construct, its association with health is more complex. Multiple individual and community level social determinants of health are defined by the social positioning of race in the U.S., while biologic differences may reflect distinct epigenetic changes and linkages to ancestral geographic origins. Together, these factors conspire to influence dialysis outcomes among African Americans with ESRD.
authors.affiliation: Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California.
authors.forename: Keith C
authors.initials: KC
authors.lastname: Norris
authors.affiliation: Department of Integrated Medical Science, Florida Atlantic University, Boca Raton, Florida.
authors.forename: Sandra F
authors.initials: SF
authors.lastname: Williams
authors.affiliation: Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California.
authors.forename: Connie M
authors.initials: CM
authors.lastname: Rhee
authors.affiliation: Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California.
authors.forename: Susanne B
authors.initials: SB
authors.lastname: Nicholas
authors.affiliation: Nephrology Section, Memphis VA Medical Center, Memphis, Tennessee.|Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Csaba P
authors.initials: CP
authors.lastname: Kovesdy
authors.affiliation: Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California.
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
authors.affiliation: Department of Medicine, Duke University, Durham, North Carolina.
authors.forename: L
authors.initials: L
authors.lastname: Ebony Boulware
mesh_terms: D001741:Black or African American / Q000208:ethnology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000628:therapy*; D009017:Morbidity / Q000639:trends; D044469:Racial Groups; D014481:United States / Q000453:epidemiology