Black and Hispanic Americans are three times and one-and-a-half times, respectively, more likely to have kidney failure compared to White Americans. Some causes are genetic, but studies have shown that health inequity is largely to blame. Addressing social determinants of health, structural racism, and implicit bias is a complex challenge that’s key to improving care in these populations. In a webinar hosted by U.S. News & World Report, experts discuss actionable solutions and meaningful policy moves to address health inequity in kidney care.* 

https://www.usnews.com/news/live-events/webinar-battling-health-disparities-in-treating-chronic-kidney-disease

Kidney Transplant Wait List

According to Elaine Ku, M.D., of the University of California San Francisco, people of color, women, and older adults are at a disadvantage on organ transplant wait lists, though there have been some recent changes to improve transplant equity, including: 

• Allowing dialysis patients to have their wait time back-dated to the day they started dialysis instead of when they were first referred and validated by a transplant center, and 
• Using a race-free equation to calculate kidney function or eGFR (estimated glomerular filtration rate) to more accurately determine kidney function and increase transplant eligibility. 

Live Organ Donors

Donating a kidney is a personal and potentially difficult choice to make. It becomes even more so when financial and health challenges can result from that choice. Some donors report being denied access to certain health insurance and/or being denied time off work following the surgery. 

The American Kidney Fund (AKF) has lobbied tirelessly for legislation to protect living donors. Now, close to 30 states have passed laws to prevent insurance discrimination and allow donors to take time off of work. 

Access for Undocumented Patients 

According to Lilia Cervantes, M.D. of the University of Colorado, Anschutz Medical Campus in Aurora, roughly 180 to 200 undocumented patients become critically ill in the emergency department each week in Colorado. This led to Colorado choosing to expand access to dialysis to undocumented immigrants with kidney failure in February 2019. Twenty states followed suit and passed similar laws. 

Insurance Costs

For many low- to middle-income individuals, insurance premiums and deductibles are simply not affordable. Some states offer financial support to help with insurance costs. AKF also offers the Health Insurance Premium Program, which pays insurance premiums for patients with kidney failure. 

Clinical Trials 

To improve care for CKD, it is imperative that research trials diversify and include patients of color. LaVarne Burton, president, and CEO of the AKF, confirms that research studies are becoming more inclusive compared to prior years. 

Deidra C. Crews, M.D., ScM, of the Johns Hopkins Center for Health Equity in Baltimore, adds that more changes could be made to allow for more people to engage in research trials. She suggests allowing for remote data collection or for data to be otherwise collected at a time and place convenient for each participant. 

Prevention 

All experts during the webinar spoke about the importance of prevention and educating communities about kidney disease. 

“One of the great positives about kidney disease is that, in an awful lot of cases, it is actually preventable,” Burton noted. “Or if not totally preventable, you can slow down the progression if you know your risk and if you follow the regimens that are recommended for you, as well as some lifestyle changes.”

Fixing healthcare inequities will be a long and multi-faceted process, but conversations to learn and acknowledge areas of opportunity will be key for long-term success. 

*Firth, S. (2023, May 15). Experts Outline Strategies for Boosting Equity in Chronic Kidney Disease. MedPage Today. https://www.medpagetoday.com/nephrology/esrd/104499