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African Americans represent about 13% of the United States population but account for more than one-third of the ESKD population. African American adults are almost four times as likely as non-Hispanic Caucasians to develop ESKD. Among men aged 20 to 39, African Americans are approximately 15 times more likely to develop ESKD secondary to hypertension than age-matched Caucasian men.
Many biologic and socioeconomic variables might influence the onset and progression of kidney disease among African Americans. Hypertension, diabetes, and obesity are associated with increased risk for ESKD and are more highly prevalent in African Americans. High blood pressure (BP) accounts for nearly one-third, and diabetes accounts for nearly half, of new cases of ESKD among this population group. The social position of African Americans in the United States and the lingering effects of legalized residential segregation place most African Americans in neighborhoods with poor health assets. They are more likely to suffer from low socioeconomic status, being uninsured or under-insured, and have low health literacy. These factors and others, such as a lack of awareness of chronic kidney disease (CKD) risk factors, contribute to the increased risk of ESKD among this group. These factors may adversely affect BP and blood glucose control in patients with hypertension and diabetes, respectively, accelerating the onset and progression of kidney disease.
Biological factors that originated as a result of shared evolutionary ancestry, such as variant APOL1 gene polymorphisms, which emerged in West Africa to protect against trypanosomiasis, and the presence of two risk alleles (present in approximately 12% of African Americans) is associated with an increased risk of developing ESKD. Other biologic markers, such as certain polymorphisms of the GSTM1 gene, an oxidative stress regulator, are associated with a reduced risk of CKD and are more prevalent among African Americans. Thus, the role of social determinants of health juxtaposed with an array of risk and resilience genes may conspire differently in varying settings to influence CKD and ESKD in African Americans.
High BP and diabetes account for nearly three-quarters of the new cases of ESKD. Diabetes alone accounts for nearly half of new ESKD cases. Increased rates of poor diabetes control among African Americans accelerate diabetes-related kidney injury. Increased rates of hypertension and poor BP control further contribute to the high prevalence of kidney disease among this patient group with diabetes.
Healthy diet
Low fat, low sodium, high potassium, and adequate calcium intake.
Regular physical activity
Increase physical activity as part of the daily routine by undertaking an enjoyable physical activity for 30 to 45 minutes per day for 3 to 5 days per week.
Weight maintenance
Monitor body weight and maintain a healthy body mass index.
Maintain weight by making permanent changes in the daily diet.
Stress reduction
Develop coping skills for specific stressors in work and/or home environment with meditation, relaxation, yoga, biofeedback, etc.
Smoking cessation
Ensure a smoke-free environment.
Recommend nutritional substitutions with foods that an individual will likely eat
Eat more broiled (grilled) and steamed foods
Eat more grains, fresh fruits, and vegetables
Eat fewer fats and use healthier fats, such as olive oil
Eat fewer processed foods, fast foods, and fried foods
Read labels and pay attention to the sodium, potassium, and fat content of foods
Do not season foods with smoked meats, such as bacon and ham hocks
If lactose intolerant, try lactose-free milk or yogurt, or drink calcium-fortified juices or soy milk
Limit alcohol consumption to <2 beers, 1 glass of wine, or 1 shot of hard liquor per day
Limit the intake of sugar-sweetened beverages and juices
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