CKD in Disadvantaged Populations

We are not all equal with regard to kidney disease and access to treatment. Some communities in both higher and lower income countries are at greater risk than others because of their ethnic origin, socioeconomic status and/or where they live. This has major public health implications because of the terrible impact of kidney failure and the extremely high cost of renal replacement therapy.

African, American Indian, Hispanic, Asian and Aboriginal populations are known to suffer from higher rates of diabetes and high blood pressure, which are leading causes of chronic kidney disease (CKD). These populations are therefore at higher risk of developing severe kidney disease and ultimately kidney failure.

In the US, for example:

  • Hispanic Americans have a 1.5 times greater risk for developing kidney failure than non-Hispanic Americans
  • ESRD rates nearly 4-fold higher among African Americans in comparison to US Whites, despite similar prevalence rate of early CKD ; Hypertension is most prevalent among African Americans (33%) and a major cause of ESRD in this population
  • Native Americans are about 1.8 times more likely to be diagnosed with kidney failure. Diabetes is the leading cause of kidney failure among American Indians.

In Australia :

  • Kidney disease is 10 times more common among Indigenous people than among non-Indigenous people
  • Indigenous Australians are almost 4 times as likely to die with CKD as a cause of death than non-Indigenous Australian.

In Canada :

  • Canadian Aboriginal people experience End Stage Renal Disease (ESRD) at rates 2.5-4 times higher than the general population

Socioeconomic and cultural factors also contribute to a disproportionate burden of kidney disease.  Language barriers, education and literacy levels, low income, unemployment, lack of adequate  health insurance, and certain culture-specific health beliefs and practices all increase the risk of developing kidney disease and limit access to preventive measures and treatment.

  • A study conducted in the UK (Sheffield) reported a greater risk of developing CKD associated with a lower socioeconomic status independently of the ethnicity of the studied population
  • Access to kidney care is limited in resource poor nations. Approximately 80% of the world’s Renal Replacement Therapy (RRT) patients live in Europe, Japan or North America. By contrast, less than 10% of Indian End Stage Kidney Disease (ESKD) patients receive RRT, while up to 70% of those starting dialysis die or stop treatment, due to cost, within the first 3 months.
  • For most Low Middle Income Countries, transplantation is rare due to lack of infrastructure, and survival can be complicated by the affordability of immunosuppressive drugs, malnutrition and infectious disease, in particular tuberculosis

CKD & Possible Environmental Factors

In addition to the traditional risk factors of Chronic Kidney Disease, such as diabetes and hypertension, and genetic traits that contribute to increase the predisposition of certain ethnicities to develop this disease, there are also other independent and, in some cases, less clear causes of CKD.

Amongst others these can be environmental conditions, exposure to heavy metals and other toxins and pollutants, dietary habits and use of non-conventional medications (traditional drugs, herbal medications..).

Examples of CKD caused by these risk factors are:

  1. Mesoamerican Nephropathy [SD4]
    Mesoamerican Nephropathy (MeN) is an alarming epidemic form of Chronic Kidney Disease of unknown origin (CKDu), prevalent in the Pacific Ocean coastal low lands of the mesoamerican region that most commonly affects young men working in sugarcane plantations.
  2. The case of Sri Lanka [SD5] Chronic kidney disease of unknown etiology is a major health care problem in the North Central Province of Sri Lanka. It is not related to common risk factors like diabetes and hypertension and is predominantly observed in low-income male agricultural laborers and paddy farmers. Heavy metal toxicity, genetic susceptibility and the possible role of repeated dehydration are the main, still debated, causes.
  3. Aristolochic acid nephropathy (AAN) [SD6]
    Aristolochic acid nephropathy (AAN), a progressive renal interstitial fibrosis frequently associated with urothelial malignancies . It was originally called Chinese Herbal Nephropathy because it is caused by the aristolochic acid contained in Chinese herbs.  Aristolochic acid nephropathy (AAN), first reported in Belgium as “Chinese herbal nephropathy”, is characterised by progressive fibrosing interstitial nephritis leading to renal failure and severe anaemia.

There is some good news though! Taking steps to live a healthy lifestyle clearly helps to reduce risk, and early detection and treatment can slow or prevent the progression of kidney disease to kidney failure, and reduce the increased incidence of cardiovascular disease associated with kidney disease.

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