Understanding kidney disease in the Black community.

One-third of American adults are at risk for kidney disease. If you are African American, Hispanic, Native American, or Asian American, you are at an even higher risk.

African Americans make up approximately 13% of the population. However, they account for 35% of people with kidney failure in the United States.

Kidney disease often develops slowly and has few symptoms at first. But there are connections between race and kidney disease and genetics and kidney disease. So, knowing your risk factors can help you be aware of any warning signs so you can get tested.

What Are Other Risk Factors for Kidney Disease?

Kidney disease can happen to anyone at any age. However, some individuals may have a higher risk of kidney disease than others. Diabetes and hypertension (high blood pressure) are the most common risk factors for kidney disease. Other conditions that may increase your risk for kidney disease include:

  • Heart disease.
  • Infections such as HIV, hepatitis B, and hepatitis C.
  • Having a family history of kidney disease.
  • Genetic factors such as race and ethnicity (especially if a given group is prone to a higher likelihood of diabetes and high blood pressure).
  • Low birth weight.
  • Obesity.

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What Are the Symptoms of Kidney Disease?

People may not experience any significant symptoms until their kidney disease is severe. Even if they do, they may have nonspecific symptoms.

Symptoms of kidney disease can include:

  • Chest pain or shortness of breath.
  • Feeling tired.
  • High blood pressure.
  • Increased or decreased urination.
  • Loss of appetite.
  • Nausea.
  • Protein in your urine.
  • Swelling in your legs.
  • Trouble sleeping.
  • Weight gain or loss.

Race and Kidney Disease

According to the National Kidney Foundation, African Americans are three times more likely to have kidney failure. Hispanics are 1.3 times more likely.

This increased risk of kidney disease and kidney failure for people of color is due to a variety of reasons. One is that minority populations sometimes have more limited access to health care options. Another is that there are higher rates of high blood pressure, diabetes, obesity, and heart disease in minority populations.

And all of these are major risk factors for kidney disease. One further reason is genetic variation from one ethnicity to another.

Kidney disease in the Black community

Diabetes is the most common cause of kidney failure. According to the American Kidney Fund, more than 10% of African American adults have diabetes. And diabetes affects them differently, causing kidney failure more often, as well as heart disease and other issues.

Similarly, high blood pressure is a major issue in the Black community, and African Americans are six times more likely to get kidney failure from it.

Race and kidney disease seem connected because Black patients are more likely to develop kidney disease at a younger age. They are also more likely to have it progress faster and experience more kidney damage.

Genetics and Kidney Disease

Different ethnicities have genetic variants that affect their overall health. These variants can explain why someone contracts or doesn’t contract certain diseases. But someone’s environment also affects these variants. The genetic variant alone is rarely the sole reason for any health issue.

What are genes?

Genes, which are part of your DNA, pass from parent to child. They tell your body which proteins to make, which determines everything from your eye color to how your body functions.

What gene variants affect kidney disease?

Generally, the APOL1 gene is part of the functioning of the immune system. A genetic variation (abnormality) in the APOL1 gene increases the chance of kidney disease for different ethnicities. This includes people who have Western and Central African ancestry or who identify as:

  • Black.
  • African American.
  • Afro-Caribbean.
  • Latina/Latino.

Everyone has two copies of the APOL1 gene, one from each parent. The mutation (abnormality) in this gene contributes to protection from a parasite that causes African sleeping sickness. If parents have this gene variation, they will pass it on to their children.

Inheriting the APOL1 variant gene can damage kidney cells, leading to kidney disease or kidney failure. People with mutations in both APOL1 genes have an increased chance of developing kidney disease.

Though there is some connection between genetics and kidney disease, not everyone with this gene variation will develop it. Environmental and personal factors like having diabetes may increase individuals’ chances of developing kidney disease.

The APOL1 gene is an important genetic factor that increases the risk of kidney disease in the African American population.

How do I know if I have APOL1 gene mutations?

Genetic testing results can tell you whether you have APOL1 gene mutations. This testing looks for gene mutations with a sample of blood or saliva (spit).

You can ask your doctor to consider genetic testing if you have kidney disease and do not know the cause or if you are considering donating a kidney. You may also consider testing if you know a family member is a carrier of the APOL1 gene mutation.

How Can I Help Prevent Kidney Disease?

Knowing your risk factors and getting tested for kidney disease will help in early detection. Additional ways you can help prevent kidney disease are:

  • Having good control of diabetes and hypertension.
  • Avoiding smoking and tobacco use.
  • Being active with regular exercise.
  • Eating healthy foods that are high in fiber and low in sodium, fat, and cholesterol.
  • Limiting alcohol intake.

Talk to your doctor about your risk factors and how often you should get tested. The earlier kidney disease is found, the easier it is to treat.

AFK's Medical Advisory Committee. APOL1-Mediated Kidney Disease. American Kidney Fund. Link

AFK's Medical Advisory Committee. Race/ethnicity — Kidney disease risk factors. American Kidney Fund. Link

Gina Kolata. Targeting the Uneven Burden of Kidney Disease on Black Americans. The New York Times. Link

Marciana Laster, MD, Jenny I. Shen, MD, MS, and Keith C. Norris, MD, PhD, FASN. American Journal of Kidney Diseases. Kidney Disease Among African Americans: A Population Perspective. National Library of Medicine. Link

National Kidney Foundation. Race, Ethnicity, & Kidney Disease. Kidney.org. Link

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