Monarch Innovation Partners, Rockville, MD, USA.
Am J Nephrol. 2017;46(2):156-164. doi: 10.1159/000479479. Epub 2017 Aug 5.
Chronic kidney disease is a progressive disease, which terminates in end-stage renal diseases (ESRD) that requires either dialysis or kidney transplantation for the patient to survive. There is an alarming trend in the disparities of ESRD in African Americans (AAs). Currently, AAs represent more than 30% of incident ESRD cases, yet they constitute 15% of the overall US population. Despite the reductions in mortality, increases in access to patient-centered home dialysis and preemptive kidney transplantation for the overall US ESRD population over the last decade, disparities in the care of AAs with ESRD remain largely unaffected.
This review discusses patient-, community-, and practitioner-related factors that contribute to disparities in ESRD care for AAs. In particular, the review addresses issues related to end-of-life support, the importance of Apolipoprotein-1 gene variants, and the advent of pharmacogenomics toward achieving precision care. The need for accessible clinical intelligence for the ESRD population is discussed. Several interventions and a call to action to address the disparities are presented. Key Messages: Significant disparities in ESRD care exist for AAs. Strategies to enhance patient engagement, education, accountable partnerships, and clinical intelligence may reduce these disparities.
慢性肾脏病是一种进行性疾病，最终会发展为终末期肾病（ESRD），患者需要透析或肾移植才能存活。非裔美国人（AAs）的 ESRD 差异存在令人震惊的趋势。目前，AAs 占新发 ESRD 病例的 30%以上，但仅占美国总人口的 15%。尽管在过去十年中，美国 ESRD 患者的死亡率有所下降，获得以患者为中心的家庭透析和预防性肾移植的机会有所增加，但 ESRD 患者的护理差异在很大程度上仍未得到解决。
本文讨论了导致非裔美国人 ESRD 护理差异的患者、社区和从业者相关因素。特别是，本文讨论了与临终关怀支持、载脂蛋白-1 基因变异体的重要性以及药物基因组学在实现精准医疗方面的应用相关的问题。本文还讨论了为 ESRD 人群提供可及临床信息的必要性，并提出了一些解决差异的干预措施和行动呼吁。
非裔美国人的 ESRD 护理存在显著差异。增强患者参与、教育、责任制合作和临床智能的策略可能会减少这些差异。
