Kidney disease is affecting Black adults at a much higher rate than many people realize, and one of the biggest problems is that someone can have it for years without knowing anything is wrong.
The CDC estimates that 22 percent of non-Hispanic Black adults have chronic kidney disease, or CKD, compared with 13 percent of non-Hispanic White adults and 12 percent of Hispanic adults. Across the country, an estimated 37 million adults have CKD, and about 87 percent of adults with the condition do not know they have it.
That lack of awareness is not necessarily because people are ignoring symptoms. Early kidney disease often does not cause any.
The kidneys filter waste and extra fluid from the blood, help control blood pressure, and perform several other jobs the body depends on. When they become damaged, kidney function can decline slowly. By the time symptoms such as swollen feet or ankles, unusual fatigue, changes in urination, foamy urine, nausea, itching, muscle cramps, or shortness of breath appear, the disease may already be more advanced.
The National Institute of Diabetes and Digestive and Kidney Diseases puts it plainly: “Testing may be the only way to know if you have kidney disease.”
For Black adults, knowing the risk factors is especially important.
Diabetes and high blood pressure are the two leading causes of CKD in adults. According to the CDC, about 38 percent of adults with diabetes are estimated to have chronic kidney disease, along with 21 percent of adults with high blood pressure. Heart disease and a family history of kidney failure can also increase risk.
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Those conditions do not affect every community equally. Black Americans experience a disproportionate burden of high blood pressure, diabetes, cardiovascular disease, and other factors connected to kidney problems.
But being Black itself is not the cause of kidney disease.
The National Kidney Foundation states, “Racial disparities in CKD stem from historical inequities, not race itself.” Access to medical care, income, neighborhood conditions, discrimination, environmental exposures, healthy food access, and other social factors can all shape health over time.
Genetics can also play a role for some people. Certain variants of the APOL1 gene are found more often in people with recent African ancestry and have been linked to a higher risk of kidney disease and faster progression in some patients. Having African ancestry does not mean someone automatically has these variants or will develop CKD, and genetics cannot explain the entire racial gap.
The disparity becomes even larger when kidney disease reaches its most serious stage.
U.S. Renal Data System data show kidney failure is more than four times as common among Black people as among White people. Black Americans make up a much smaller share of the total U.S. population but account for roughly 30 percent of people living with kidney failure.
Kidney failure can require dialysis or a kidney transplant to survive.
The goal is to catch kidney disease long before it reaches that point.
Two tests are especially important. A blood test is used to calculate estimated glomerular filtration rate, usually called eGFR, which estimates how well the kidneys are filtering blood. A urine albumin to creatinine ratio, or UACR, checks whether a protein called albumin is leaking into the urine. Healthy kidneys normally keep most albumin in the bloodstream.
A lower eGFR or elevated urine albumin can signal kidney trouble, although one abnormal result does not always establish chronic kidney disease. CKD generally involves evidence of kidney damage or reduced kidney function that persists for more than three months.
People with diabetes, high blood pressure, cardiovascular disease, or a family history of kidney failure should talk with a health care professional about kidney testing. Screening everyone without risk factors is not currently universally recommended.
Finding kidney disease early can create more time to slow its progression. Controlling blood pressure and blood sugar, taking prescribed medications correctly, avoiding unnecessary kidney-harming medications or supplements, and following a treatment plan can help protect remaining kidney function.
It is also worth knowing your actual numbers. A routine appointment may include a creatinine result or eGFR, but patients should not assume every physical automatically includes the urine albumin test used to look for kidney damage.
For Black adults, that conversation can be especially important because the numbers show both a higher burden of CKD and a dramatically higher burden of kidney failure.
Kidney disease can stay quiet. Asking how well your kidneys are working does not have to.
