How does one truly live free without the benefit of good health? How is it that so many of us are enslaved to ailments, which are preventable if caught early? Parts of the answers lie in the knowledge we develop of our bodies and the basic understanding of abnormal functioning of our organs and their interaction. One disease that has a direct impact on the liberty of life is kidney disease. Its somewhat silent progression too often shackles the strength of our bodies and minds; sometimes leading to untimely death!
Chronic Kidney Disease (CKD) is defined as a decrease in the function of the basic unit of the kidney (called the glomerulus) and /or an anatomic disorder of the organ. In 2003, 20 million people were estimated to have CKD in the United States. This equates to one (1) in nine (9) adults in the population. 20 million more Americans are at risk for this condition. CKD is broken down into 5 stages. Stage 1 is mild kidney disease and affected 5.9 million people. Stage 2 affected 5.3 million people; stage 3 had 7.6 million people; stage 4 had 500,000. Stage 5 is termed End Stage Renal Disease (ESRD); this stage affected 406,000 people. There are more people today in each stage of disease. In fact, ESRD is expected to grow to 650,000 people by 2010.
Chronic Kidney Disease affects other systems including the skeletal system, the immune system, the hematopoietic system (which is responsible for blood cell production) and several body regulatory systems. Most importantly, there is a direct correlation with increased rates of cardiovascular disease as kidney function declines. In fact, one source illustrates that kidney disease is related to heart attack and stroke, fifty percent (50%) more that diabetes! The epidemic of Kidney Disease affects minority populations at an increased rate; this is particularly true for the African-American population.
Chronic Kidney Disease incidence according to the second National Health and Nutrition Survey Mortality Study (NHANES II) is about 2.7 times higher for African-Americans than their White counterparts. A study published in the Journal of the American Society of Nephrology (JASN) in 2002 revealed that African-Americans with CKD progress to ESRD 8.9 times more than Whites. It is interesting that the two major causes of CKD, diabetes and hypertension, affect African-Americans more than Whites. Also, these diseases tend to manifest much earlier and more severely in Blacks. In fact, for both hypertension and diabetes, the rates of developing kidney disease in the Black population are much higher. However, it is unclear why the rates are so different. In fact, the study in JASN suggested “nearly one half of the excess risk of CKD among African-American adults can be explained by potentially modifiable risk factors…much of the excess risk remains unexplained.”
The impact of kidney disease on the Black population has important ramifications given the body systems that it affects. Cardiovascular Disease produces an increased morbidity and mortality in the Black population. The extent to which kidney disease directly affects these rates is not known. However, we do know that, in general, people with CKD have a decreased life expectancy, which is mostly related to cardiovascular events. For instance, for a 49 year old with ESRD, the life expectancy is 7.1 years. This is compared to colon cancer (8.6 years), prostate cancer (12.8 years) and the general population (29.8 years).