Crews Deidra C, Liu Yang, Boulware L Ebony
aDivision of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine bWelch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions cDivision of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland dDivision of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
Curr Opin Nephrol Hypertens. 2014 May;23(3):298-305. doi: 10.1097/01.mnh.0000444822.25991.f6.
Racial, ethnic and socioeconomic disparities in chronic kidney disease (CKD) have been documented for decades, yet little progress has been made in mitigating them. Several recent studies offer new insights into the root causes of these disparities, point to areas in which future research is warranted, and identify opportunities for changes in policy and clinical practice.
Recently published evidence suggests that geographic disparities in CKD prevalence exist and vary by race. CKD progression is more rapid for racial and ethnic minority groups compared with whites and may be largely, but not completely, explained by genetic factors. Stark socioeconomic disparities in outcomes for dialysis patients exist and vary by race, place of residence, and treatment facility. Disparities in access to living kidney donation may be driven primarily by the socioeconomic status of the donor as opposed to recipient factors.
Recent studies highlight opportunities to eliminate disparities in CKD, including efforts to direct resources to areas and populations where disparities are most prevalent, efforts to understand how to best use emerging information on the contribution of genetic factors to disparities, and continued work to identify modifiable environmental, social, and behavioral factors for targeted interventions among high-risk populations.
慢性肾脏病（CKD）中的种族、民族和社会经济差异已被记录数十年，但在缓解这些差异方面进展甚微。最近的几项研究为这些差异的根本原因提供了新见解，指出了未来研究的重点领域，并确定了政策和临床实践变革的机会。
最近发表的证据表明，CKD患病率存在地理差异，且因种族而异。与白人相比，少数种族和民族群体的CKD进展更快，这在很大程度上（但并非完全）可由遗传因素解释。透析患者的结局存在明显的社会经济差异，且因种族、居住地点和治疗机构而异。活体肾捐赠机会的差异可能主要由捐赠者的社会经济地位而非受者因素驱动。
最近的研究突出了消除CKD差异的机会，包括将资源导向差异最普遍的地区和人群的努力，理解如何最佳利用关于遗传因素对差异贡献的新信息的努力，以及持续致力于识别可改变的环境、社会和行为因素以对高危人群进行针对性干预的工作。
