To have and have not: Health and health care disparities in chronic kidney disease

The case presented today is a vivid representation of the epidemic of chronic kidney disease that is disproportionately affecting ethnic minorities in the United States and the challenges that occur in achieving optimal outcomes for such patients. The excess risk of chronic kidney disease among minorities, particularly African Americans, is multifactorial and due to potentially modifiable risk factors such as access to care, improved health behaviors, and better overall clinical management. Although African Americans on dialysis have better survival rates than do whites for unclear reasons, evidence suggests that blacks receive peritoneal dialysis less often, receive inadequate doses of dialysis, and are less likely to undergo transplantation. Promotion of social justice, including fair allocation of health resources, is one of the important principles of medical professionalism embraced by physicians [68]. Physicians who care for patients with chronic kidney disease should try to understand the barriers that lead to inequalities in care. We should work to narrow and ultimately eliminate these disparities.