#NephMadness 2017: Crews Contemplates the Limits of Choice

Posted on March 27, 2017 by AJKDblog in NephMadness // 1 Comment

Deidra C. Crews

Dr. Crews, MD, is Associate Professor of Medicine in the Division of Nephrology at the Johns Hopkins University School of Medicine and Associate Vice Chair for Diversity and Inclusion in the Department of Medicine. Her core area of research addresses disparities in the care and outcomes of chronic kidney disease. Follow her @DrDeidraCrews.

Choices…choices…There are too many good choices in the NephMadness Disparities Region! It reminds me of my days playing small forward at Chatham High School, home of the Cavaliers. Back then, I could go right, or I could go left…which in my case, meant a high likelihood of having the ball stolen from me by the opposing team. In fact, I once stole the ball from the other team, only to then dribble towards their basket, until I was ‘alerted’ by my coach who was nearly called for a technical because he stepped so far out onto the court to try to stop me from shooting the ball at the wrong basket!

Fortunately, I also had other choices—medical school, whose pursuit rescued me from any illusions I had of a career as a WBNA player. But for far too many socially-disadvantaged people with or at risk for CKD, there are limited choices for avoiding progression to ESKD.

They may want to go right and start off on a good course, only to find out that their socioeconomic status across their full life course will predict their risk of ESKD. They may want to go left and get their hypertension under control, but may find that perceptions of discrimination leave their BP registering high. They may want to go for a jump shot, and control their diabetes, but find their sugars drop at the end of the month, when nutrition assistance runs low. They may want to jog up and down the court to help maintain a healthy weight, but find few safe places for recreation in their neighborhoods. While they may leap high, they miss the dunk when it comes to following a healthful diet that may help them delay kidney function decline and keep their minerals in check. They dream of a buzzer beating 3-pointer, gaining them access to nephrology care, but find that the racial composition of their neighborhood predicts their access to a nephrologist.

Socially-disadvantaged people face significant barriers to self-care and prevention of CKD and CKD progression. They deserve our attention and pursuit of effective strategies to remove and help them overcome these barriers.

That is why my pick for NephMadness 2017 is Society in ESKD Disparity.

Read more about Society in ESKD in the Disparities in Nephrology region.

– Guest Post written by Deidra C. Crews (@DrDeidraCrews)

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