J Natl Med Assoc
-
Review
"Can i donate a kidney?" Common questions and simplified answers to the prospective kidney donor.
For individuals with end stage kidney disease (ESKD), kidney transplantation is associated with reduced morbidity, mortality, and decreased health care costs. African Americans have higher rates of end stage kidney disease (ESKD) and reduced access to transplantation compared to their White counterparts. One way to improve access to transplantation is by increasing the number of living donors. ⋯ Often individuals with ESKD are hesitant to inform loved ones about living donation out of concerns that their donors may feel pressured or may be harmed by donation. Even when patients discuss donation with loved ones, these potential donors may not seek information from their physicians. As an important first step, we provide general information about living donation to primary care physicians for their African Americans patients with ESKD and potential African American donors.
-
Lupus Nephritis is a complex clinical manifestation of systemic lupus erythematosus (SLE) associated with significant morbidity and mortality. It disproportionately affects minorities, especially African Americans (AA) with higher rates of progression to end stage kidney disease. Several factors are implicated including genetic predisposition to both SLE and chronic kidney disease, social determinants of health such as income inequality, education disparities, social isolation/lack of support, health care access and affordability. ⋯ Fortunately, clinical trials have shown a favorable benefit/response among African Americans to mycophenolate mofetil. However, newer and alternative agents such as Rituximab, Belimumab and Voclosporin are widely unaffordable, and AA remain underrepresented in these clinical trials. The current state of disparities affecting LN patients of AA ancestry is a call for better access to healthcare and social support systems, greater inclusion/representation in clinical trials, and making new and alternative regimens more affordable and cost effective.
-
Recent recognitions of longstanding societal effects of structural and overt acts of racism have led to calls for the elimination of race, a social construct, from medical algorithms. This accelerated a growing concern with the use of race in kidney function estimating equations. ⋯ We herein review the journey of kidney function estimating equations, race in GFR estimating equations, new race-free equations and the path forward in caring for chronic kidney disease. We urge upon all primary care providers to employ concerted focus on early detection and identification of kidney dysfunction as well as risk factors including social determinants of health to prevent progression.
-
An estimated 37 million Americans have chronic kidney disease (CKD). Primary care providers (PCPs) have long played a critical role in detecting CKD and preventing disease progression, particularly in the early stages of the disease. ⋯ Health disparities in nephrology have recently come to the forefront - again, PCPs will play a key role in efforts to reduce such disparities and ensure all patients receive high quality care. This review summarizes the latest guidelines for treatment of CKD and its complications, explores health disparities affecting patients with CKD, and highlights the role of the PCP in caring for this population.
-
A need exists to examine racial disparities in the healthcare arena and the impact on patients with cancer. Despite ongoing efforts to increase equity in primary healthcare access, racial and socioeconomic disparities persist, thus contributing to disproportionate treatment outcomes and survivorship among minority and low-income patients. Such disparities have been revealed in treatment cohorts of patients with multiple forms of cancer, including breast, cervical, ovarian, endometrial, prostate, lung, colorectal, gastrointestinal, and hepatocellular, and have been attributed to a range of co-occurring behavioral, social determinants of health, underlying genetic factors, as well as access to educational opportunities that limit the quality of informed healthcare. ⋯ This requires developing a system of justice and trust based on specific, solution-oriented grassroots community efforts working in tandem with medical and pharmaceutical leaders. By fully exploring and pinpointing the underlying causes of healthcare disparities, it should be possible to define strategies and interventions most likely to transform cancer care. The ultimate goal is understanding individual, cultural, and biological vulnerabilities, including environmental and epigenetic liabilities, to optimize cancer prevention, diagnosis, and treatment.