By Kiara Doyal, The Seattle Medium
March is National Kidney Disease Awareness Month, a month that aims to raise awareness about the disease, its prevention, treatment, and the importance of early detection. According to the National Kidney Foundation, Black people are more than three times as likely to have kidney failure compared to White people, and the Black community has much higher rates of high blood pressure, diabetes, and heart disease, all of which increase the risk for kidney disease.
One factor contributing to the disproportionate rates of kidney disease among Black Americans is a genetic variant known as APOL1. While everyone has the APOL1 gene, certain high-risk variants are far more common in people of West African ancestry. These variants are believed to increase the likelihood of developing kidney disease.
“There are a few things that can hurt your kidneys that are more common in Black people,” said Dr. Justin Bullock, a nephrologist at University of Washington Medicine–Harborview Medical Center. “One is lupus, and one is the APOL1 gene, a protein involved in the body’s immune system and cholesterol metabolism.”
According to Bullock, researchers are actively studying APOL1 to better understand which variants are linked to kidney damage and how they affect the body. The goal is to develop more precise treatments and preventative strategies for those at greater genetic risk.
“On top of APOL1, if you have any other risk factors for kidney disease, like diabetes, it often is associated with a much more advanced kidney disease for Black people,” said Bullock.
Despite the seriousness of the condition, kidney disease is often preventable and manageable. A balanced diet, regular exercise, and awareness of personal risk factors can play a major role in delaying or preventing its progression.
“I see in a lot of patients that when they feel bad, it is easier for them to get help and take medication consistently,” said Bullock. “But it is a lot harder when people feel good and are unaware. We actually have a lot of good medicines and treatments, even in the last 10 years, that really help to slow down kidney disease.”
Given that high blood pressure is prevalent in the Black community, Bullock advises people to adopt a low-sodium, plant-based diet and to engage in regular exercise.
“A high amount of salt in your diet makes your body hold on to water, so you can have more swelling,” says Bullock. “And the protein that comes from animals causes higher levels of acid in the kidney, which can speed up kidney disease.”
“I encourage an activity where you are slightly out of breath, because that is stressing your heart enough to make it stronger, and the number one killer of people with kidney disease is heart disease,” added Bullock.
Kidney disease is often called a silent killer because most people don’t show signs or symptoms until it becomes severe. As a result, many patients are diagnosed late in the progression of the disease and are immediately placed on dialysis, which is why early detection is so important.
“Once your kidney disease is very advanced there’s not as much that we can do, compared to if we found it earlier,” Bullock said. “Some symptoms include itchy skin, your food can taste metallic, swelling to your body, and high levels of potassium in your blood — which all happen from toxins blowing up in your body due to the disease.”
“However, most people get to actual kidney failure when their kidney function is down to about five to seven percent of normal kidney function, which is extremely low,” added Bullock.
When patients visit their primary care doctor for routine check-ups, and screening for conditions like diabetes and high blood pressure, Bullock also recommends having regular visits, at least once a year, to detect kidney disease early.
“There are five stages of kidney disease. One is the mildest, and five is the most severe,” said Bullock. “We recommend that people see a kidney doctor when they get to stage three, when kidney function is less than 60% of normal.”
According to Bullock, there are two ways that kidney disease progresses in two ways — acute and chronic.
“Chronic kidney injury/disease means that there has likely been some scarring in the kidney, and once a kidney has a scar, you can’t reverse the scar and it won’t heal itself,” said Bullock. “Acute kidney injury/disease means your kidney isn’t scarred yet and we can recover a lot of the function.”
Bullock also pointed to social and systemic factors that make Black Americans more vulnerable, including limited access to healthcare and past misinformation in the medical community.
“There used to be messaging from the medical community that there were some medicines that people were told weren’t good for Black people,” said Bullock. “And it turned out that that was wrong information. The medicines are very protective of people with kidney disease when prescribed correctly.”
He also said increasing awareness is essential because people often don’t know they have the disease until it’s too late.
“Education is so important because people need to know whether or not they have kidney disease so we can get them on the medicines to help,” said Bullock. “Once you pass the age of 40, everyone loses about 1% of their kidney function over time, but if you have other conditions, it could speed it up.”
Effective treatments are available to slow the progression of kidney disease—but they only work if people are aware and diagnosed early. Bullock said he is often disheartened by how many patients are unaware of their own kidney health.
“As a kidney doctor and as a Black person, kidneys are kind of in the background for the rest of your body,” he said. “We always say the kidneys are your favorite organ’s favorite organ. Your heart, lungs, and liver all love your kidneys.”
“When there are problems with the kidneys, it really can affect so much of people’s quality of life,” Bullock added. “And it is heartbreaking when someone doesn’t know that they have kidney problems—or that they can get treatment.”
