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1 Chapter 1 : The burden of chronic kidney disease Kidney Diseases in the Developing World and Ethnic Minorities is a chapter, page book describing the epidemiological, organizational, and financial challenges of CKD in India, South America, Africa, Russia, and China and in ethnic minorities in the United States, United Kingdom, and Australia. Its editor, Dr Meguid El Nahas, is a leading. People inherit one form of the ApoE gene from each parent. Those who inherit it from both parents have an even higher risk. Hispanics who inherited the e4 form from one parent had a 2. On the other hand, blacks who inherited the e4 form from one parent and Hispanics who inherited it from both parents did not have increased risks. What are health disparities? Sex, sexual identity, age, disability, socioeconomic status, geographic location, race and ethnicity all influence health 1. If a health outcome is seen to a greater or lesser extent in certain populations, there is a disparity. Biological, genetic, environmental and cultural factors and access to medical care all play a role. Compelling evidence indicates race and ethnicity correlate with increasing health disparities between U. Heart disease death rates are more than 40 percent higher for blacks than for whites 2. Blacks who receive drug-coated stents have more than double the rate of clotting compared with those of other races despite taking anti-clotting medications 3. Interestingly, Mexican-Americans show a blunted response to insulin 4, which may be one of the causes. Furthermore, Hispanics are almost twice as likely to die from diabetes as are non-hispanic whites 5, 6. The diabetes rate for American Indians and Alaska Natives is more than twice that for whites. This risk is due in part to high rates of diabetes and high blood pressure in these communities. Blacks make up about 13 percent of the U. Since, the number of Hispanics with kidney failure has increased by more than 70 percent 7. American Indians also are disproportionately affected. Compared with whites, they are 1. American Indians and Alaska Natives have an infant death rate almost double that for whites. CANCER The death rate for all cancers is 30 percent higher for blacks than for whites; for prostate cancer, for example, the death rate for blacks is more than double that for whites. Black women have a higher death rate from breast cancer despite having a mammography screening rate nearly on par with that of white women 8. Of the cities where black women were more likely to die of breast cancer, that disparity ranged from a 24 percent higher risk of death in New York to more than twice the risk of death in Memphis between and Older Hispanics are 1. Final thoughts While scientific advances have increased longevity and improved quality of life for Americans, racial and ethnic minorities have not experienced these gains equally. Advancing scientific knowledge and technology can improve patient-centered research in the areas of prevention, screening, diagnostics and treatment, and it can strengthen existing information systems to improve the quality of health, public health and biomedical research. It makes a big difference when breast cancer is diagnosed early; when a patient having a heart attack is given the correct treatment quickly; when medications are correctly administered; and when doctors listen to their patients and their families, show them respect and answer their questions in a culturally and linguistically skilled manner. To better reach out to all the different ethnic groups, it pays for the medical community to develop cultural and linguistic skills. Strategies include expanding the use of interpreters, improving the quality of patient-provider interactions in clinical settings, improving cultural-competence education and training for health-care professionals, and increasing racial and ethnic diversity in the health-care work force. It is necessary to educate physicians about pervasive racial and ethnic health disparities and to assist them in developing strategies to deliver quality care to underserved populations. In addition, we must foster the training of scientists with the best biochemical and molecular technologies to investigate the causes of many the diseases prevalent among minorities. Journal of Health Care for the Poor and Underserved 23, 1 â 6 Circulation, â United States â National Health Statistics Reports 50 National Kidney Foundation Breast Cancer Rates by Race and Ethnicity. Centers for Disease Control and Prevention Cancer Epidemiology 36, â Frank Talamantes lactogen mouseplacenta. Page 1

2 Chapter 2 : ASBMB Minority Affairs: U.S. health disparities at a glance Kidney Diseases in the Developing World and Ethnic Minorities Edited by Meguid El Nahas, Rashad S. Barsoum, John Dirks, ethnic minorities in the United Kingdom, and Australian aboriginal pop. This article has been cited by other articles in PMC. The number of patients with chronic kidney disease worldwide is rising markedly. In Europe, less than 0. The huge disparity in the prevalence of this disease between the industrialised world and emerging nations reflects different priorities for health care and the inadequacy of resources allocated to renal replacement therapy. Programmes to detect chronic kidney disease, linked to comprehensive primary and secondary prevention strategies, are needed urgently. In Singapore, the national kidney foundation has launched a nationwide comprehensive screening and detection programme for chronic kidney disease. Yet most clinical practice guidelines now recommend identifying those at riskâ people with hypertension, diabetes, obesity, and other predisposing conditions or medicines as well as older people and relatives of patients with chronic kidney disease. Serum creatinine is a readily available and reliable indicator of chronic kidney disease but it may be altered by a variety of factors, and renal function may be compromised considerably before serum creatinine concentrations rise. Reporting of serum creatinine is nowadays often linked to that of a calculated glomerular filtration rate. Structured and well resourced primary prevention programmes based on reducing the risk factors for chronic kidney disease could make a big difference. Such a multifactorial approach to risk reduction may slow or even reverse declining renal function. Maintenance dialysis population dynamics: J Am Soc Nephrol ; Ansell D, Feest T, eds. UK renal registry report UK Renal Registry, Am J Kidney Dis ;45 suppl 1. Global burden of diabetes, Outcomes and economics of ESRF. El Nahas AM, ed. Kidney diseases in the developing world and ethnic minorities. Taylor and Francis, Microalbuminuria is common, also in a nondiabetic, nonhypertensive population, and an independent indicator of cardiovascular risk factors and cardiovascular morbidity. J Intern Med ; Datta M, Mani MK. Community-based approach to prevention of chronic kidney disease: Chronic kidney disease in Aboriginal Australians. Taking a public health approach to the prevention of end-stage renal disease: Kidney Int ; suppl Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Am J Kidney Dis ; Early detection of kidney disease in community settings. The kidney early evaluation programme KEEP. Am J Kidney Dis ;39 suppl 1: Am J Kidney Dis ;43 suppl 2: Kidney prevention recipes for your office practice. Kidney Int ;67 suppl Page 2

3 Chapter 3 : Race, Ethnicity, & Kidney Disease NIDDK Kidney Diseases in the Developing World and Ethnic Minorities - CRC Press Book Compiled by an international team of nephrologists, this reference covers a wide variety of clinical, regional, and research issues related to the epidemiology, diagnosis, and treatment of kidney disease in ethnic populations-exploring current prevention strategies. African American, Hispanic and Native Americans. ESRD incidence is also higher among the less advantaged indigenous populations in developed countries. In Australia, the increase in the number of indigenous people starting renal replacement therapy RRT over the past 25 years exceeded that of the nonindigenous population by 3. Indigenous populations also have a higher incidence of ESRD due to glomerulonephritis and hypertension [ 13 ]. CKD in developing countries Poverty-related factors such as infectious diseases secondary to poor sanitation, inadequate supply of safe water, environmental pollutants and high concentrations of disease-transmitting vectors continue to play an important role in the development of CKD in low-income countries. Although rates of diabetic nephropathy are rising, chronic glomerulonephritis and interstitial nephritis are among the principal causes of CKD in many countries. Male farmworkers are affected disproportionately, and the clinical presentation is suggestive of interstitial nephritis, confirmed on renal biopsies. The strong association with farm work has led to suggestions that exposure to agrochemicals, dehydration and consumption of contaminated water might be responsible [ 20 ]. Additionally, the use of traditional herbal medications is common and frequently associated with CKD among the poor [ 21, 22 ]. Low birth weight and risk of CKD in the disadvantaged populations An association between low birth weight LBW, due primarily to nutritional factors, and kidney disease has been described in disadvantaged populations. The frequency of LBW is more than double in the Aboriginal population than in the non-aboriginal population of Australia. The high prevalence of albuminuria in this population has been linked to low nephron number related to LBW [ 27, 28 ]. Morphometric studies of kidney biopsies in the Aboriginals show glomerulomegaly, perhaps secondary to nephron deficiency, which might predispose to glomerulosclerosis [ 29, 30 ]. Similarly, in an Indian cohort, LBW and early malnutrition were associated with later development of metabolic syndrome, diabetes and diabetic nephropathy [ 32 ]. The finding of a high prevalence of proteinuria, elevated blood pressure and CKD of unknown etiology in South Asian children may also be explained by this mechanism [ 33, 34 ]. Disparities in access to renal replacement therapy A recent analysis shows that globally, there were 2. In contrast, the number of people requiring RRT was estimated at 4. Even though diabetes and hypertension increase the burden of CKD, the current provision of RRT is linked largely to two factors: By, the number of people receiving RRT around the world is projected to increase to 5. Most of this increase will be in developing countries of Asia and Africa T. Access to RRT in the emerging world is dependent mostly on the health-care expenditures and economic strength of individual countries, with the relationship between income and access to RRT being almost linear in low- and middle-income countries [ 19, 35 ]. Additionally, developing countries have low transplant rates because of a combination of low levels of infrastructure; geographical remoteness; lack of legislation governing brain death; religious, cultural and social constraints; and commercial incentives that favor dialysis [ 38 ]. There are also differences in utilization of renal replacement modalities between indigenous and nonindigenous groups in the developed countries. In Australia and New Zealand, the proportion of people receiving home dialysis is considerably lower among indigenous people. The rate of kidney transplantation is also lower among disadvantaged communities. In the UK, white individuals from socially deprived areas, South Asians and blacks were all less likely to receive a pre-emptive renal transplant or living donor transplants than their more affluent white counterparts [ 9 ]. Disparities in renal care are more evident in developing nations. Data from India show that there are fewer nephrologists and nephrology services in the poorer states. As a result, people living in these states are likely to receive less care [ 40 ]. In Mexico, the fragmentation of the health-care system has resulted in unequal access to RRT. In the state of Jalisco, the acceptance and prevalence rates in the more economically Page 3

4 advantaged insured population were higher and pmp, respectively than for patients without medical insurance 99 and pmp, respectively. The transplant rate was also dramatically different, at 72 pmp for those with health insurance and 7. The bidirectional relationship between poverty and CKD In addition to having a higher disease burden, the poor have limited access to resources for meeting the treatment costs. A large proportion of patients who are forced to meet the expensive ESRD treatment costs by incurring out-of-pocket expenditure get pushed into extreme poverty. Entire families felt the impact of this, including job losses and interruptions in education of children. Outcomes Overall, mortality rates among those who do receive RRT are higher in the indigenous, minorities and the uninsured populations, even after adjustment for comorbidities. The hazard ratios for death on dialysis relative to the nonindigenous group are 1. The Canadian First Nations patients achieve target levels for blood pressure and mineral metabolism less frequently [ 44 ]. In the USA, living in predominantly black neighborhoods was associated with higher than expected mortality rates on dialysis and increased time to transplantation [ 45 ]. Similarly, black patients on peritoneal dialysis had a higher risk of death or technique failure compared with whites [ 46 ]. In Mexico, the mortality on peritoneal dialysis is 3-fold higher among the uninsured population compared with Mexican patients receiving treatment in the USA, and the survival rate is significantly lower than the insured Mexican population [ 47 ], while in India almost two-thirds of the patients are unable to continue dialysis beyond the first 3 months due to financial reasons [ 48 ]. Summary The increased burden of CKD in disadvantaged populations is due to both global factors and population-specific issues. Low socioeconomic status and poor access to care contribute to health-care disparities and exacerbate the negative effects of genetic or biologic predisposition. Provision of appropriate renal care to these populations requires a two-pronged approach: Kidney transplantation should be promoted by expanding deceased donor transplant programs and use of inexpensive, generic immunosuppressive drugs. The International Society of Nephrology is addressing these challenges through its Research and Prevention Committee as well as its Educational programs. The message of WKD is that a concerted attack against the diseases that lead to ESRD, by increasing community outreach, better education, improved economic opportunity and access to preventive medicine for those at highest risk, could end the unacceptable relationship between CKD and disadvantage in these communities. Initiatives such as the CKD hotspots and CKJ reviews series in this journal may help increase the awareness and facilitate the concerted efforts of health-care workers, epidemiologists, basic researchers and policy makers to decrease the burden of CKD C. Ortiz, submitted for publication. Conflict of interest statement None declared. Page 4

5 Chapter 4 : Kidney Health in Disadvantaged Populations Committee Compiled by an international team of nephrologists, this reference covers a wide variety of clinical, regional, and research issues related to the epidemiology, diagnosis, and treatment of kidney disease in ethnic populations-exploring current prevention strategies, treatment outcomes, and education and training practices in Africa, South America, Asia, as well as China, India, Pakistan, and. Reviews Summary Compiled by an international team of nephrologists, this reference covers a wide variety of clinical, regional, and research issues related to the epidemiology, diagnosis, and treatment of kidney disease in ethnic populations-exploring current prevention strategies, treatment outcomes, and education and training practices in Africa, South America, Asia, as well as China, India, Pakistan, and Russia. This reference also addresses specific issues pertinent to the renal healthcare of ethnic minorities in the United States, Europe, and Australia. Table of Contents Epidemiology. Clinical Issues and Challenges. Infections and Kidney Diseases: A Continuing Global Challenge. Viral Infections and the Kidney: A Major Problem in Developing Countries. Present and Future Challenges. Albuminuria a New Target for Therapy: Treat the Kidney to Protect the Heart. Renal Transplantation in Developing Countries. Chronic Kidney Disease in Aboriginal Australians. A Specialty Preparing for the 21st Century. Renal Disease in SubSaharan Africa. Research and Links Models: The Renal Sister Center: Nephrology Training in the Developing World. Training and Education of Nephrologists World-wide. Education and Training in Nephrology in Africa. A Global View of Nephrology Reviews "â El Nahas and his coeditors have done a wonderful job of presenting in a single book the problem of kidney disease in developing countriesâ. Page 5

6 Chapter 5 : Publications - Wits University Note: Citations are based on reference standards. However, formatting rules can vary widely between applications and fields of interest or study. The specific requirements or preferences of your reviewing publisher, classroom teacher, institution or organization should be applied. Find articles by G. This article has been cited by other articles in PMC. Martin Luther King Jr. Since its inception in, WKD has become the most successful effort ever mounted to raise awareness among decision-makers and the general public about the importance of kidney disease. Each year WKD reminds us that kidney disease is common, harmful and treatable. This article reviews the key links between poverty and CKD and the consequent implications for the prevention of kidney disease and the care of kidney patients in these populations. Chronic kidney disease is increasingly recognized as a global public health problem and a key determinant of the poor health outcomes. Although the entire population of some low and middle-income countries could be considered disadvantaged, further discrimination on the basis of local factors creates a position of extreme disadvantage for certain population groups peasants, those living in some rural areas, women, the elderly, religious minorities, etc. The fact that even in developed countries, racial and ethnic minorities bear a disproportionate burden of CKD and have worse outcomes, suggests there is much to learn beyond the traditional risk factors contributing to CKD-associated complications. Poverty negatively influences healthy behaviors, health care access and environmental exposure, all of which contribute to health care disparities[ 2 ] [ Table 1 ]. The poor are more susceptible to disease because of lack of access to goods and services, in particular clean water and sanitation, information about preventive behaviors, adequate nutrition, and reduced access to health care. African-American, Hispanic and Native Americans. Chronic Kidney Disease in Developing Countries Poverty-related factors such as infectious diseases secondary to poor sanitation, inadequate supply of safe water, environmental pollutants and high concentrations of disease-transmitting vectors continue to play an important role in the development of CKD in low-income countries. Although rates of diabetic nephropathy are rising, chronic glomerulonephritis and interstitial nephritis are among the principal causes of CKD in many countries. Male farm workers are affected disproportionately, and the clinical presentation is suggestive of interstitial nephritis, confirmed on renal biopsies. The strong association with farm work has led to suggestions that exposure to agrochemicals, dehydration, and consumption of contaminated water might be responsible. The frequency of LBW is more than double in the aboriginal population than in the non-aboriginal population of Australia. The high prevalence of albuminuria in this population has been linked to low nephron number related to LBW. By contrast, the number of people requiring RRT was estimated at 4. Even though diabetes and hypertension increase the burden of CKD, the current provision of RRT is linked largely to two factors - per capita GNP and age, suggesting that poverty is a major disadvantage for receiving RRT. By, the number of people receiving RRT around the world is projected to increase to 5. Most of this increase will be in developing countries of Asia and Africa. In Australia and New Zealand, the proportion of people receiving home dialysis is considerably lower among indigenous people. In the UK, white individuals from socially deprived areas, South Asians and blacks were all less likely to receive a preemptive renal transplant or living donor transplants than their more affluent white counterparts. Data from India shows that there are fewer nephrologists and nephrology services in the poorer states. As a result, people living in these states are likely to receive less care. In the state of Jalisco, the acceptance and prevalence rates in the more economically advantaged insured population were higher pmp and pmp, respectively than for patients without medical insurance 99 pmp and pmp, respectively The transplant rate also was dramatically different, at 72 pmp for those with health insurance and 7. A large proportion of patients who are forced to meet the expensive ESRD treatment costs by incurring out-of-pocket expenditure, get pushed into extreme poverty. The hazard ratios for death on dialysis relative to the nonindigenous group are 1. Low socioeconomic status and poor access to care Page 6

7 contribute to health care disparities, and exacerbate the negative effects of genetic or biologic predisposition. Provision of appropriate renal care to these populations requires a two-pronged approach: Expanding the reach of dialysis through development of low-cost alternatives that can be practiced in remote locations, and implementation and evaluation of cost-effective prevention strategies. Kidney transplantation should be promoted by expanding deceased donor transplant programs and use of inexpensive, generic immunosuppressive drugs. The message of WKD is that a concerted attack against the diseases that lead to ESRD, by increasing community outreach, better education, improved economic opportunity, and access to preventive medicine for those at highest risk, could end the unacceptable relationship between CKD and disadvantage in these communities. Global approaches for understanding the disproportionate burden of chronic kidney disease. Poverty, race, and CKD in a racially and socioeconomically diverse urban population. Am J Kidney Dis. Report of the Commission on Macroeconomics and Health. Investing in Health for Economic Development. Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients. Racial differences in the progression from chronic renal insufficiency to end-stage renal disease in the United States. J Am Soc Nephrol. Norris K, Nissenson AR. The Jackson Heart Study. Neighborhood poverty and racial differences in ESRD incidence. Can we separate the effects of social deprivation and ethnicity? Kidney Int Suppl ;3: Ethnic disparities in prevalence and impact of risk factors of chronic kidney disease. Prevalence of chronic kidney disease and survival among aboriginal people. Kidney disease in Maori and Pacific people in New Zealand. Kidney disease among the indigenous peoples of Oceania. United States Renal Data System: American Indian heritage and risk factors for renal injury. An epidemic of proteinuria in Pima Indians with type 2 diabetes mellitus. Kidney disease among the Zuni Indians: The Zuni Kidney Project. Global dimension and perspectives. Chronic kidney disease of unknown etiology in agricultural communities. Towards prevention of chronic kidney disease in Nigeria; a community-based study in Southeast Nigeria. Acute renal failure following the use of herbal medicines. East Afr Med J. Identifying undetected cases of chronic kidney disease in Mexico. Prevalence of chronic kidney disease in an urban Mexican population. Marker or target in indigenous populations. Renal function and cardiovascular risk markers in a remote Australian Aboriginal community. Renal biopsy findings among Indigenous Australians: Distribution of volumes of individual glomeruli in kidneys at autopsy: Association with age, nephron number, birth weight and body mass index. Low birth weights contribute to high rates of early-onset chronic renal failure in the Southeastern United States. Relation of serial changes in childhood body-mass index to impaired glucose tolerance in young adulthood. N Engl J Med. Proteinuria in South Asian children: Children in South Asia have higher body mass-adjusted blood pressure levels than white children in the United States: Worldwide access to treatment for end stage kidney disease: Chronic kidney disease in the developing world. Latin American Dialysis and Transplant Registry: Current status of end-stage renal disease care in India and Pakistan. World Kidney Day Steering Committee The global role of kidney transplantation. Indigenous people in Australia, Canada, New Zealand and the United States are less likely to receive renal transplantation. Current status of chronic kidney disease care in southeast Asia. Renal replacement therapy among disadvantaged populations in Mexico: Ramachandran R, Jha V. Kidney transplantation is associated with catastrophic out of pocket expenditure in India. Burden of end-stage renal disease among indigenous peoples in Australia and New Zealand. Alberta Kidney Disease Network. Quality of care among Aboriginal hemodialysis patients. Clin J Am Soc Nephrol. Relationships among urban residential segregation, dialysis facilities, and patient outcomes. Neighborhood location, rurality, geography, and outcomes of peritoneal dialysis patients in the United States. Survival among patients with kidney failure in Jalisco, Mexico. Referral pattern of patients with end-stage renal disease at a public sector hospital and its impact on outcome. Natl Med J India. Page 7

8 Chapter 6 : Kidney Diseases in the Developing World and Ethnic Minorities - CRC Press Book BOOK REVIEW Kidney Diseases in the Developing World and Ethnic Minorities Editor: Meguid El Nahas Publisher: Taylor & Francis C HRONIC KIDNEYDISEASE (CKD) now. Publications Publications Naicker S. End-stage renal disease in sub-saharan and South Africa. Hepatitis C virus and primary glomerulonephritis: Clinical Nephrology, ; Molecular genetics of human cervical cancer: Biol Chem, ; 6: Demographic and epidemiologic transition in the developing world: Role of albuminuria in the early diagnosis and prevention of renal and cardiovascular disease. Loss of health professionals from sub-saharan Africa: Guidelines for the treatment and management of new-onset diabetes after transplantation. Guideline for the management of nosocomial urinary tract infections. Prevention of chronic kidney and vascular disease: Toward global health equity- The Bellagio Declaration. A dominant player in chronic kidney disease. A cross-sectional study of HIV-seropositive patients with varying degrees of proteinuria in South Africa. Kidney Int ; Guideline for the management of nosocomial infections in South Africa. S Afr Med J, July ; 96 7: Migration of health professionals from Sub-Saharan Africa: Transactions Jan-June ; 50 1: Chronic kidney disease in human immunodeficiency virus infection. Chronic kidney disease in HIV infection: SAMJ March;98 3: Peritoneal dialysis in South Africa- a single centre experience. Indian J Peritoneal Dialysis. Causes and predictors of death in South Africans with systemic lupus erythematosus. George J, Fabian J. Chronic kidney disease management--what can we learn from South African and Australian efforts? A time bomb of cardiovascular risk factors in South Africa: The use of a cyclosporin-ketoconazole combination: Eur J Clin Pharmacol. Epub Apr 9. Chapter 7 : Chronic kidney disease in disadvantaged populations Compiled by an international team of nephrologists, this reference covers a wide variety of clinical, regional, and research issues related to the epidemiology, diagnosis, and treatment of kidney disease in ethnic populations-exploring current prevention strategies, treatment outcomes, and education and training practices in Africa, South. Chapter 8 : Committee For Kidney Health in Disadvantaged Populations In comparison to our study ours shows that the participant come dominantly from Addis Ababa and Oromia region (%) and (%) respectively. Page 8