Background: Chronic kidney disease is a progressive disease, which terminates in end-stage renal diseases (ESRD) that requires either dialysis or kidney transplantation for the patient to survive. There is an alarming trend in the disparities of ESRD in African Americans (AAs). Currently, AAs represent more than 30% of incident ESRD cases, yet they constitute 15% of the overall US population. Despite the reductions in mortality, increases in access to patient-centered home dialysis and preemptive kidney transplantation for the overall US ESRD population over the last decade, disparities in the care of AAs with ESRD remain largely unaffected. Summary: This review discusses patient-, community-, and practitioner-related factors that contribute to disparities in ESRD care for AAs. In particular, the review addresses issues related to end-of-life support, the importance of Apolipoprotein-1 gene variants, and the advent of pharmacogenomics toward achieving precision care. The need for accessible clinical intelligence for the ESRD population is discussed. Several interventions and a call to action to address the disparities are presented. Key Messages: Significant disparities in ESRD care exist for AAs. Strategies to enhance patient engagement, education, accountable partnerships, and clinical intelligence may reduce these disparities.

1.
Saran R, Li Y, Robinson B, Ayanian J, Balkrishnan R, Bragg-Gresham J, Chen JT, Cope E, Gipson D, He K, Herman W, Heung M, Hirth RA, Jacobsen SS, Kalantar-Zadeh K, Kovesdy CP, Leichtman AB, Lu Y, Molnar MZ, Morgenstern H, Nallamothu B, O'Hare AM, Pisoni R, Plattner B, Port FK, Rao P, Rhee CM, Schaubel DE, Selewski DT, Shahinian V, Sim JJ, Song P, Streja E, Kurella Tamura M, Tentori F, Eggers PW, Agodoa LY, Abbott KC: US renal data system 2014 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis 2015;66(1 suppl 1):Svii, S1-S305.
3.
Kidney Disease Statistics for the United States: National Kidney and Urologic Diseases Information Clearinghouse, NIH Publication No. 12-3895, 2012, pp 1-16.
5.
Choi AI, Rodriguez RA, Bacchetti P, Bertenthal D, Hernandez GT, O'Hare AM: White/black racial differences in risk of end-stage renal disease and death. Am J Med 2009;122:672-678.
6.
Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS: Prevalence of chronic kidney disease and decreased kidney function in the adult us population: third national health and nutrition examination survey. Am J Kidney Dis 2003;41:1-12.
7.
Collins AJ, Foley RN, Chavers B, Gilbertson D, Herzog C, Johansen K, Kasiske B, Kutner N, Liu J, St Peter W, Guo H, Gustafson S, Heubner B, Lamb K, Li S, Li S, Peng Y, Qiu Y, Roberts T, Skeans M, Snyder J, Solid C, Thompson B, Wang C, Weinhandl E, Zaun D, Arko C, Chen SC, Daniels F, Ebben J, Frazier E, Hanzlik C, Johnson R, Sheets D, Wang X, Forrest B, Constantini E, Everson S, Eggers P, Agodoa L: United States renal data system 2011 annual data report: atlas of chronic kidney disease & end-stage renal disease in the United States. Am J Kidney Dis 2012;59(1 suppl 1):A7.e1-e420.
8.
Collins AJ, Foley RN, Herzog C, Chavers B, Gilbertson D, Ishani A, Kasiske B, Liu J, Mau LW, McBean M, Murray A, St Peter W, Guo H, Gustafson S, Li Q, Li S, Li S, Peng Y, Qiu Y, Roberts T, Skeans M, Snyder J, Solid C, Wang C, Weinhandl E, Zaun D, Arko C, Chen SC, Dalleska F, Daniels F, Dunning S, Ebben J, Frazier E, Hanzlik C, Johnson R, Sheets D, Wang X, Forrest B, Constantini E, Everson S, Eggers P, Agodoa L: US renal data system 2010 annual data report. Am J Kidney Dis 2011;57(1 suppl 1):A8.e1-e526.
9.
Jayasinghe S: Chronic kidney disease of unknown etiology should be renamed chronic agrochemical nephropathy. MEDICC Rev 2014;16:72-74.
10.
Friedman DJ, Pollak MR: Genetics of kidney failure and the evolving story of APOL1. J Clin Invest 2011;121:3367-3374.
11.
Pollak MR: Familial FSGS. Adv Chronic Kidney Dis 2014;21:422-425.
12.
Guan M, Ma J, Keaton JM, Dimitrov L, Mudgal P, Stromberg M, Bonomo JA, Hicks PJ, Freedman BI, Bowden DW, Ng MC: Association of kidney structure-related gene variants with type 2 diabetes-attributed end-stage kidney disease in African Americans. Hum Genet 2016;135:1251-1262.
13.
Powe NR, Melamed ML: Racial disparities in the optimal delivery of chronic kidney disease care. Med Clin North Am 2005;89:475-488.
14.
Ward MM: Socioeconomic status and the incidence of ESRD. Am J Kidney Dis 2008;51:563-572.
15.
Evans RW, Blagg CR, Bryan FA Jr: Implications for health care policy. A social and demographic profile of hemodialysis patients in the United States. JAMA 1981;245:487-491.
16.
Alves TP, Wang X, Wright JT Jr, Appel LJ, Greene T, Norris K, Lewis J; AASK Collaborative Research Group: Rate of ESRD exceeds mortality among African Americans with hypertensive nephrosclerosis. J Am Soc Nephrol 2010;21:1361-1369.
17.
Klag MJ, Whelton PK, Randall BL, Neaton JD, Brancati FL, Stamler J: End-stage renal disease in African-American and white men. 16-year MRFIT findings. JAMA 1997;277:1293-1298.
18.
Crews DC, Charles RF, Evans MK, Zonderman AB, Powe NR: Poverty, race, and CKD in a racially and socioeconomically diverse urban population. Am J Kidney Dis 2010;55:992-1000.
19.
Lipworth L, Mumma MT, Cavanaugh KL, Edwards TL, Ikizler TA, Tarone RE, McLaughlin JK, Blot WJ: Incidence and predictors of end stage renal disease among low-income blacks and whites. PLoS One 2012;7:e48407.
20.
Nicholas SB, Kalantar-Zadeh K, Norris KC: Socioeconomic disparities in chronic kidney disease. Adv Chronic Kidney Dis 2015;22:6-15.
21.
Feder J, Nadel MV, Krishnan M: A matter of choice: opportunities and obstacles facing people with ESRD. Clin J Am Soc Nephrol 2016;11:536-538.
22.
Kazley AS, Johnson E, Simpson K, Chavin K, Baliga P: African American patient knowledge of kidney disease: a qualitative study of those with advanced chronic kidney disease. Chronic Illn 2015;11:245-255.
23.
Cukor D, Kimmel PL: Education and end of life in chronic kidney disease: disparities in black and white. Clin J Am Soc Nephrol 2010;5:163-166.
24.
Salter ML, Kumar K, Law AH, Gupta N, Marks K, Balhara K, McAdams-DeMarco MA, Taylor LA, Segev DL: Perceptions about hemodialysis and transplantation among African American adults with end-stage renal disease: inferences from focus groups. BMC Nephrol 2015;16:49.
25.
Norris KC, Nicholas SB: Racial disparities in end-of-life issues in patients with chronic kidney disease. Am J Nephrol 2016;44:81-83.
26.
Perry E, Swartz J, Brown S, Smith D, Kelly G, Swartz R: Peer mentoring: a culturally sensitive approach to end-of-life planning for long-term dialysis patients. Am J Kidney Dis 2005;46:111-119.
27.
Cort MA: Cultural mistrust and use of hospice care: challenges and remedies. J Palliat Med 2004;7:63-71.
28.
Reese DJ, Ahern RE, Nair S, O'Faire JD, Warren C: Hospice access and use by African Americans: addressing cultural and institutional barriers through participatory action research. Soc Work 1999;44:549-559.
29.
Blackhall LJ, Frank G, Murphy ST, Michel V, Palmer JM, Azen SP: Ethnicity and attitudes towards life sustaining technology. Soc Sci Med 1999;48:1779-1789.
30.
Burrs FA: The African American experience: breaking the barriers to hospices. Hosp J 1995;10:15-18.
31.
Dupree CY: The attitudes of black Americans toward advance directives. J Transcult Nurs 2000;11:12-18.
32.
Gordon AK: Deterrents to access and service for blacks and hispanics: the medicare hospice benefit, healthcare utilization, and cultural barriers. Hosp J 1995;10:65-83.
33.
Krakauer EL, Crenner C, Fox K: Barriers to optimum end-of-life care for minority patients. J Am Geriatr Soc 2002;50:182-190.
34.
OMara AM, Arenella C: Minority representation, prevalence of symptoms, and utilization of services in a large metropolitan hospice. J Pain Symptom Manage 2001;21:290-297.
35.
Garrett JM, Harris RP, Norburn JK, Patrick DL, Danis M: Life-sustaining treatments during terminal illness: who wants what? J Gen Intern Med 1993;8:361-368.
36.
Schena FP: Biomarkers and personalized therapy in chronic kidney diseases. Expert Opin Investig Drugs 2014;23:1051-1054.
37.
Cykert S, Jones JD, Kissling G, Hansen CJ: Racial differences in patients' perceptions of debilitated health states. J Gen Intern Med 1999;14:217-222.
38.
Caralis PV, Davis B, Wright K, Marcial E: The influence of ethnicity and race on attitudes toward advance directives, life-prolonging treatments, and euthanasia. J Clin Ethics 1993;4:155-165.
39.
Arenella C: Hospice and palliative care for African Americans: overcoming disparities. J Palliat Med 2016;19:126.
40.
Colon M, Lyke J: Comparison of hospice use by European Americans, African Americans, and latinos: a follow-up study. Am J Hosp Palliat Care 2015;32:205-209.
41.
Boulware LE, Troll MU, Jaar BG, Myers DI, Powe NR: Identification and referral of patients with progressive CKD: a national study. Am J Kidney Dis 2006;48:192-204.
42.
Nicholas SB, Tareen N, Zadshir A, Martins D, Pan D, Norris KC: Management of early chronic kidney disease in indigenous populations and ethnic minorities. Kidney Int Suppl 2005;97:S78-S81.
43.
Kao WH, Klag MJ, Meoni LA, Reich D, Berthier-Schaad Y, Li M, Coresh J, Patterson N, Tandon A, Powe NR, Fink NE, Sadler JH, Weir MR, Abboud HE, Adler SG, Divers J, Iyengar SK, Freedman BI, Kimmel PL, Knowler WC, Kohn OF, Kramp K, Leehey DJ, Nicholas SB, Pahl MV, Schelling JR, Sedor JR, Thornley-Brown D, Winkler CA, Smith MW, Parekh RS; Family Investigation of Nephropathy and Diabetes Research Group: MYH9 is associated with nondiabetic end-stage renal disease in African Americans. Nat Genet 2008;40:1185-1192.
44.
Genovese G, Friedman DJ, Ross MD, Lecordier L, Uzureau P, Freedman BI, Bowden DW, Langefeld CD, Oleksyk TK, Uscinski Knob AL, Bernhardy AJ, Hicks PJ, Nelson GW, Vanhollebeke B, Winkler CA, Kopp JB, Pays E, Pollak MR: Association of trypanolytic Apol1 variants with kidney disease in African Americans. Science 2010;329:841-845.
45.
Tzur S, Rosset S, Shemer R, Yudkovsky G, Selig S, Tarekegn A, Bekele E, Bradman N, Wasser WG, Behar DM, Skorecki K: Missense mutations in the APOL1 gene are highly associated with end stage kidney disease risk previously attributed to the MYH9 gene. Hum Genet 2010;128:345-350.
46.
Uhlen M, Fagerberg L, Hallstrom BM, Lindskog C, Oksvold P, Mardinoglu A, Sivertsson A, Kampf C, Sjostedt E, Asplund A, Olsson I, Edlund K, Lundberg E, Navani S, Szigyarto CA, Odeberg J, Djureinovic D, Takanen JO, Hober S, Alm T, Edqvist PH, Berling H, Tegel H, Mulder J, Rockberg J, Nilsson P, Schwenk JM, Hamsten M, von Feilitzen K, Forsberg M, Persson L, Johansson F, Zwahlen M, von Heijne G, Nielsen J, Ponten F: Proteomics. Tissue-based map of the human proteome. Science 2015;347:1260419.
47.
Vanhamme L, Paturiaux-Hanocq F, Poelvoorde P, Nolan DP, Lins L, Van Den Abbeele J, Pays A, Tebabi P, Van Xong H, Jacquet A, Moguilevsky N, Dieu M, Kane JP, De Baetselier P, Brasseur R, Pays E: Apolipoprotein L-I is the trypanosome lytic factor of human serum. Nature 2003;422:83-87.
48.
Tishkoff SA, Reed FA, Friedlaender FR, Ehret C, Ranciaro A, Froment A, Hirbo JB, Awomoyi AA, Bodo JM, Doumbo O, Ibrahim M, Juma AT, Kotze MJ, Lema G, Moore JH, Mortensen H, Nyambo TB, Omar SA, Powell K, Pretorius GS, Smith MW, Thera MA, Wambebe C, Weber JL, Williams SM: The genetic structure and history of Africans and African Americans. Science 2009;324:1035-1044.
49.
Dummer PD, Limou S, Rosenberg AZ, Heymann J, Nelson G, Winkler CA, Kopp JB: APOL1 kidney disease risk variants: an evolving landscape. Semin Nephrol 2015;35:222-236.
50.
Papeta N, Kiryluk K, Patel A, Sterken R, Kacak N, Snyder HJ, Imus PH, Mhatre AN, Lawani AK, Julian BA, Wyatt RJ, Novak J, Wyatt CM, Ross MJ, Winston JA, Klotman ME, Cohen DJ, Appel GB, D'Agati VD, Klotman PE, Gharavi AG: APOL1 variants increase risk for FSGS and HIVAN but not IgA nephropathy. J Am Soc Nephrol 2011;22:1991-1996.
51.
Mersha TB, Abebe T: Self-reported race/ethnicity in the age of genomic research: Its potential impact on understanding health disparities. Hum Genomics 2015;9:1.
54.
Mizzi C, Peters B, Mitropoulou C, Mitropoulos K, Katsila T, Agarwal MR, van Schaik RH, Drmanac R, Borg J, Patrinos GP: Personalized pharmacogenomics profiling using whole-genome sequencing. Pharmacogenomics 2014;15:1223-1234.
55.
Phelps KR, Mason DL, Stote KS: Phosphate homeostasis, parathyroid hormone, and fibroblast growth factor 23 in stages 3 and 4 chronic kidney disease. Clin Nephrol 2016;85:251-261.
57.
Williams AW: Health policy, disparities, and the kidney. Adv Chronic Kidney Dis 2015;22:54-59.
58.
Gao SW, Oliver DK, Das N, Hurst FP, Lentine KL, Agodoa LY, Sawyers ES, Abbott KC: Assessment of racial disparities in chronic kidney disease stage 3 and 4 care in the department of defense health system. Clin J Am Soc Nephrol 2008;3:442-449.
59.
Lockridge RS, Kjellstrand CM: Nightly home hemodialysis: outcome and factors associated with survival. Hemodial Int 2011;15:211-218.
60.
Wallace EL, Lea J, Chaudhary NS, Griffin R, Hammelman E, Cohen J, Sloand JA: Home dialysis utilization among racial and ethnic minorities in the United States at the national, regional, and state level. Perit Dial Int 2017;37:21-29.
61.
Patzer RE, Gander J, Sauls L, Amamoo MA, Krisher J, Mulloy LL, Gibney E, Browne T, Plantinga L, Pastan SO; Southeastern Kidney Transplant Coalition: The radiant community study protocol: community-based participatory research for reducing disparities in access to kidney transplantation. BMC Nephrol 2014;15:171.
63.
Waterman AD, Peipert JD, Goalby CJ, Dinkel KM, Xiao H, Lentine KL: Assessing transplant education practices in dialysis centers: comparing educator reported and medicare data. Clin J Am Soc Nephrol 2015;10:1617-1625.
64.
Garonzik-Wang JM, Berger JC, Ros RL, Kucirka LM, Deshpande NA, Boyarsky BJ, Montgomery RA, Hall EC, James NT, Segev DL: Live donor champion: finding live kidney donors by separating the advocate from the patient. Transplantation 2012;93:1147-1150.
65.
Agodoa L, Eggers P: Racial and ethnic disparities in end-stage kidney failure-survival paradoxes in African-Americans. Semin Dial 2007;20:577-585.
66.
Kucirka LM, Grams ME, Lessler J, Hall EC, James N, Massie AB, Montgomery RA, Segev DL: Association of race and age with survival among patients undergoing dialysis. JAMA 2011;306:620-626.
67.
Reddan DN, Szczech LA, Klassen PS, Owen WF Jr: Racial inequity in America's ESRD program. Semin Dial 2000;13:399-403.
68.
Wimalawansa SA, Wimalawansa SJ: Environmentally induced, occupational diseases with emphasis on chronic kidney disease of multifactorial origin affecting tropical countries. Ann Occup Environ Med 2016;28:33.
69.
Huang CW, Syed-Abdul S, Jian WS, Iqbal U, Nguyen PA, Lee P, Lin SH, Hsu WD, Wu MS, Wang CF, Ma KL, Li YC: A novel tool for visualizing chronic kidney disease associated polymorbidity: a 13-year cohort study in Taiwan. J Am Med Inform Assoc 2015;22:290-298.
71.
https://www.healthypeople.gov/ (accessed April 27, 2017).
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