By D. Kevin McNeir,
Special to the AFRO
Leading members of America’s medical community along with health advocates and nonprofit organizations are focusing their efforts on raising awareness and recommending resources for those impacted by chronic kidney disease.
For African Americans, particularly, who are disparately affected by the disease, experts say it is crucial to understand the important role that kidneys play in one’s life, how to determine if one may have kidney disease and how to prevent or slow the progression of the disease.
In exclusive interviews with two of the nation’s top physicians and experts in the field of nephrology – Dr. Clive Callender and Dr. Deidra Crews – The AFRO posed a series of questions to both doctors about kidney disease, including ways to prevent the disease and how it’s treated. In particular, we wanted to know why Blacks, despite being just 13 percent of the population, are disproportionately far more likely to both develop and die from chronic kidney disease than any other race/ethnic group in America.
But before our readers discount the information these dedicated physicians shared, consider how the disease has impacted the life of one hardworking entrepreneur from the Bronx.
Jerry White, 61, born and raised in the Bronx, New York, went to his physician just over a year ago for treatment from shingles. Routine blood and urine work revealed that he had chronic kidney disease (CDK). Since then, he’s been in and out of the hospital for complications related to CDK and is in stage 5 which means his kidneys are no longer working, with waste building up in his blood, making him very sick.
White said lack of knowledge has changed his life forever.
“If I had any signs, I didn’t recognize them or pay attention to them,” White said during a recent telephone conversation from his hospital bed.
“Like a lot of people, I never paid attention to the importance of kidney health or getting tested regularly. Just this month (March), I’ve been in the hospital three times, most recently because of blood clots in my legs and one of my feet. It’s painful to walk, and my doctors, even though I’m on blood thinners, aren’t sure what’s going on with my body.”
Since his diagnosis last year, White said he has totally changed his diet–no more fast food, no more fried food and very little meat.
“I have a pretty bland diet these days: no sugar, no salt, no seasoning, no processed meat,” he said. “I still eat a little chicken and fish but definitely no pork or beef. And I exercise and meditate every day. My doctor said only 30 percent of my kidneys is functioning at this point, so I have to also monitor my blood pressure. One doctor told me she was amazed that I’m still alive – I forced her to tell me the truth.
“One thing’s for sure – it certainly slowed me down and forced me to take account of how I was living. I used to do a lot of recreational drugs and ate just about everything. I don’t do either of those things anymore. And while it may seem hard for others to believe, I am staying really positive despite how this disease is slowly destroying my body.”
He added, “As long as I’m able, I hope to volunteer and visit others facing chronic kidney disease and encourage them. It can be a very lonely journey and a lot of patients I’ve seen during my many times in the hospital are all alone. Fortunately, I’m not. And I have faith. But it’s hard sometimes. What’s really tough is realizing that I could have prevented this.”
Knowledge is Power
CKD is common among U.S. adults with more than 1 in 7 (14 percent) estimated to have the disease – that’s about 35.5 million people, according to the CDC. As many as 9 in 10 adults with CKD do not know they have it; about 1 in 3 adults with severe CKD do not know they have the disease.
Based on current estimates, CKD is more common in people 65 or older (34 percent) than in those ages 45-64 (12 percent) or 18-44 (6 percent).
The disease is more common in women (14 percent) than men, but among Black men, 1 in 9 will develop kidney failure in their lifetime. In addition, CKD is more common in non-Hispanic Black adults (20 percent) than in non-Hispanic Asian adults (14 percent) or non-Hispanic White adults (12 percent).
So, what happens when people develop CKD? First, their kidneys become damaged and over time may not clean the blood as well as healthy kidneys. If kidneys do not work well, toxic waste and extra fluid accumulate in the body and may lead to high blood pressure, heart disease, stroke and early death. However, people with CKD and people at risk for CKD can take steps to protect their kidneys with the help of their health care providers.
Dr. Crews, professor of medicine in the Division of Nephrology at Johns Hopkins Center for Health Equity, said while it’s true that people who have African ancestry are more genetically predisposed to develop kidney disease, it doesn’t mean that all Blacks will develop the disease.
“There are other things that lead to kidney disease, particularly racial disparities, which are profound and are not fully explained by genes,” she said. “I focus on things like Blacks being burdened more than others with poverty, living in communities where they lack healthy food, clean water and safe places to live – all of which contribute to the disease. With a genetic background and with the social risk factors I’ve mentioned, the chance of developing kidney disease increases significantly.”
Dr. Crews emphasized the importance of people becoming more aware about CKD.
“Far more Black families than Whites have someone in their family who’s either being treated with kidney dialysis or who has received a kidney transplant,” she said. “Still, many Blacks do not understand why or how to prevent the disease. They only know they have family members affected by kidney disease. The good news is we’re on the cusp of developing medications that we believe will one day help us prevent conditions like diabetes which disproportionately impacts Blacks and often leads to kidney disease.
“Further, getting tested regularly for diabetes or high blood is especially important for Blacks as is eating more heart-healthy food like fruits and vegetables and exercising daily,” she said.
Dr. Clive Callender is a professor of surgery at the Howard University College of Medicine and the founder and president of The National Minority Organ Tissue Transplant Education Program (MOTTEP). Dr. Callender, who has worked for more than 50 years as a transplant surgeon, agreed with Dr. Crews, saying Blacks must be more aware of the prevalence of CKD within the Black community and how changes in lifestyle can either prevent the disease or slow its progression.
“People of color, mostly African Americans, are the people you see who usually fill most of the kidney dialysis units anywhere you go in the U.S.,” he said. “We’re 13 percent of the population but make up 35 percent of those who suffer from kidney failure. That’s because we suffer at a greater percentage than others from high blood pressure, diabetes and obesity. And that’s without factoring in a person’s genetics. This is serious.”
Still, Dr. Callender said there are ways to avoid developing kidney disease – and it’s not that difficult.
“I recommend the following: 1) exercise for at least 150 minutes per week; 2) change your diet to one that is plant-protein focused, eliminating fried foods or red meat and, at a minimum, reduce the amount of meat you eat; 3) meditate each day; 4) drink a lot of water; and 5) reduce or even eliminate salt from your diet. That’s because salt contributes to hypertension and high blood pressure is something that must be treated on its own, just like obesity must be.
“When considering the five stages of kidney disease, the first three stages are reversible if a person is diagnosed early and follows their doctor’s advice. However, other problems are more difficult to overcome which often lead to chronic kidney disease like institutionalized racism.”
Dr. Callender said he hopes more Blacks will consider becoming kidney donors.
“Right now, 17 people die each day waiting for a kidney because there’s such a severe shortage of donors,” he said. “It’s estimated that 90,000 people are on wait lists for a kidney but we only perform about 40,000 transplants each year. We need more Blacks to consider being living donors, especially when one realizes that 59 percent of those waiting for a kidney transplant are Black.
“Deceased donations remain the No. 1 way that a person receives a kidney but the wait time is much greater for those patients – sometimes five years or more. But for living donations, the wait time can be as short as three to six months and there’s a greater survival rate following surgery when one receives a kidney from a living donor, especially with the newer meds that help the body to accept the new kidney and not reject it,” he emphasized.