Nearly 35% of People with Kidney Failure are Black - Why?

You read that right.

Kidney failure, known in medical circles as end-stage renal disease (ESRD), casts a heavy shadow over Black folks in the United States. Nearly 35 percent of those grappling with this condition are Black, even though they make up just 13 percent of the population.

It’s a stark reminder of how uneven health burdens can be, and how a fundamental lack of awareness can worsen it all.

But what’s really causing all this? Is it just one big tangled web of inherited risks, life circumstances, and a broken healthcare system?

In truth, this troubling trend boils down to a handful of key struggles.

Let’s break down what they are and why they matter so that you’re armed with all the information you need!

Genetics & Environment

Genetics throws a curveball right from the start for Black individuals. One gene called APOL1—more common in people with African roots—is tied to kidney trouble in a big way. A study in The New England Journal of Medicine found that having two risky versions of this gene increases the odds of serious kidney damage.

These conditions you may have heard of, such as focal segmental glomerulosclerosis or hypertension-driven ESRD. In some cases, these and other conditions may increase in likelihood by as much as ten times.

It’s not a sure ticket to kidney failure, but when high blood pressure and diabetes combine with other issues, those odds climb fast.

According to the CDC, Black adults are 60 percent more likely to deal with high blood pressure and 2.3 times more likely to face diabetes than white adults. These aren’t just numbers—they’re relentless pressures that batter the kidneys’ filtering system until it starts to give out.

The American Heart Association adds that hypertension in Black folks often kicks in younger and harder, speeding up the damage.

Some reports show that the glomerular filtration rate—a term for how well kidneys clean the blood—drops quicker than in other racial groups, even if everyone starts at the same rate. This decline is likely related to comorbidities like hypertension, diabetes, and mutations in the APOL1 gene.

For some, it can be a brutal progression that leaves little room for error.

The good news is that it can be addressed by simply knowing your risk factors and taking appropriate actions.

We’ll get into that a little later…

Lack of Adequate Healthcare

Early care can catch kidney trouble before it’s a runaway train, but that’s not the reality for many Black patients. One main reason for this is the shortage of necessary doctor visits. Steady checkups—where doctors might spot chronic kidney disease (CKD) early—aren’t as common in Black communities.

Due to doctor shortages, a lack of clinics and hospitals, and serious financial burdens, many diagnoses come too late. By then, the damage is deep, and options start shrinking fast.

Unfortunately, the medications that could slow this down, like ACE inhibitors for blood pressure or SGLT2 inhibitors to ease kidney strain, don’t reach Black patients as often. Many of these potential lifesavers get prescribed less to Black folks with early CKD.

Is it because of doctors not understanding enough? Could it be the lack of insurance coverage? Is it due to a lack of specialists who could bridge the gap?

The answer is: all of the above.

It’s a quiet tragedy—meds that could help sit on shelves while kidneys falter.

Knowing Risk Factors

For those whose kidneys give out, a transplant is a golden ticket to a better life, but Black patients hit wall after wall. In fact, Black individuals are less likely to land on the transplant waitlist, and when they do, they’re stuck waiting 4.5 years on average—two years longer than white patients.

Fewer family members can donate, money troubles compound, and doctors may be less likely to even bring up the possibility of the treatment after a while.

Now for some good news.

Knowing family history—especially if kidneys have been a weak spot—can spark a push for genetic counseling. Keeping blood pressure and diabetes in check with diet, exercise, and pills can slow the damage down to a crawl.

Those concerned can also ask for tests, like serum creatinine or albuminuria checks, to further check for any issues down the road.

Then there are the specialists. Pushing for a nephrologist’s expertise or meds like ACE inhibitors isn’t just smart—it’s a lifeline. Community locations such as free clinics or health fairs, like those the National Kidney Foundation runs, are invaluable as well.

As always, staying clued in matters. It’s important that you learn about kidney health from solid sources and pass this down to others. Lean on family members who have been there, or at least know about the struggle.

Because Black folks bear so much of the kidney failure load, something like 35 percent it’s important to take a multi-pronged approach. Remember, that kidney damage and kidney disease can take many forms. It’s not always extremely severe, and you shouldn’t be afraid to address the problem.

Through both preventative measures and treatment options, you can effectively manage many kidney issues.

Again, don’t forget that the problem is multifaceted. Kidney failure is a more serious problem, and it comes from genetic mutations in APOL1, a flood of chronic ills, and a healthcare setup that’s less than ideal. Although the hurdles may be steep, no doubt, they can certainly be cleared.

Just be honest, take a practical approach, and don’t let the potential negatives prevent you from healthy, happy living. Yes, it is true that Black individuals face risks of faster disease, later diagnoses, and poorer health outcomes, but a lot of this is relatively easily fixed.

Big fixes—like better access, sharper research, and policies that level the field—are happening all the time. We simply need to continue to push their development.

So, let’s not get discouraged, let’s not lose hope. Whether you personally are impacted by kidney problems, know somebody with kidney issues, or simply want to stay informed, you have many options.

Stay focused, stay aware, and enjoy the healthy, happy life you deserve!