Kidney Disease in the Hispanic Population

Sylvia E. Rosas @sylviaerosas

Sylvia E. Rosas, MD, MSCE is a nephrologist and epidemiologist at the Joslin Diabetes Center and an Associate Professor of Medicine at Harvard Medical School. Dr. Rosas has evaluated health disparities in individuals with CKD particularly in those of Hispanic/Latino background.  She is the President Elect of the National Kidney Foundation and chairs the NKF Health Equity Advisory Committee.

Katelyn Laue @Katelynengel

Katelyn Laue is a Registered Dietitian and MPH, currently serving as the Senior Director of Program Development at the National Kidney Foundation. In this role she works on the creation and implementation of innovative programs for to improve prevention, early diagnosis, and management of kidney disease, with a focus on programs that improve population health and advance health equity. Katelyn obtained her Masters in Public Health from the University of Minnesota and completed her Registered Dietitian training through the University of South Dakota Sanford School of Medicine and the College of St. Benedict.

We are celebrating Hispanic Heritage month.

Hispanics are at increased risk for chronic kidney disease (CKD), progress faster and reach kidney failure replacement therapy at an earlier age. It is estimated that 13.6% of adults in the United States of Hispanic background have CKD. The Hispanic population in the United States, which includes people of any race, was 18.7% or 62.1 million individuals in 2020. Importantly, the Hispanic population continues to grow at a faster rate than non-Hispanic [23% vs 4.3%] in the last decade.

At the National Kidney Foundation (NKF), we recognize that the underlying factors driving this disproportionate impact are not solely genetics or family history, but rather social determinants of health (SDOH) and a disproportionate lack of access to resources for being healthy. SDOH—the non-medical factors that have an impact on our health—include affordable healthy foods, stable housing, safe places for physical activity, and health care that is affordable, accessible, and culturally relevant. Due to historic and current structural and systemic racism access to these resources is disproportionately distributed, with communities of color—including Hispanic and Latino communities—often having less access.

These are the driving forces behind disparities in rates of CKD and CKD outcomes, and are central to the NKF health equity strategy for programs and activities. Our goal is to advance programs that are equitable, inclusive, locally focused, and accessible to all communities impacted by kidney disease, especially communities of color and marginalized populations. We aim to be a trusted resource, connector, convener, and partner working with communities to address inequities through programs and policies that remove structural and systemic barriers to kidney health.

Unfortunately, our reach into Hispanic and Latino communities is limited, relative to the impact of CKD on these populations. For example, less than 10% of attendees at Big Ask Big Give programs self-identified as Hispanic, compared with nearly 18% of the end-stage kidney disease population who identifies as Hispanic, and we see similar results with our Cares helpline and Your Kidneys and You program. But we are working to improve our reach and better serve these communities.

This work begins with ensuring that our programs, and resources are available in both Spanish and English. Many of our live, in-person programs like the Big Ask, Big Give and Your Kidneys and You have been translated in Spanish and have already been offered in several states. We are working to offer more programming in Spanish including our peer mentoring program NKF PEERs (coming at the end of fall 2022), and our Kidney Learning Center on-demand programs include Spanish closed captioning with a goal of building a fully translated Spanish version for all educational material. The NKF website has over 100 pages in Spanish with over 100,000 views per month.

In addition, our local teams are workings towards implementing best practices to increase accessibility and the cultural relevance of our programs by having interpreters available, having printed material in multiple languages, featuring patient panels and speakers with diverse backgrounds and lived experiences, and considering factors like location and transportation options when planning in-person programs to increase accessibility and attendance.

While each local market is different, many are working on building relationships with key community partners that serve the Hispanic and Latino communities, such as consulates, chambers of commerce, community service organizations, Community Health Workers or Promoters, and federally qualified health centers/safety net health settings. These partners help to inform our program content and delivery and help to increase our reach into new communities who have not yet been connected to NKF. These partnerships can also help us to connect participants with programs or services to address social determinants of health, ensuring that those we serve have access to the resources they need to live healthy lives.

On a recent trip to Texas, I learned that the NKF Serving Texas has partnered with Mexican Consulates across Texas, the Guatemalan Consulate in Del Río, educational institutions, radio stations, and community organizations to effectively collaborate to provide free kidney health screenings and promote kidney health through education and awareness. The KEEP Healthy 2.0 has served over 1,500 individuals over the last year. KEEP Healthy is the NKF community-based educational initiative to raise awareness about kidney health, risk factors for kidney disease, and steps to take to keep kidneys healthy and reduce risk. It now incorporates a virtual risk quiz, “Minute for your kidneys” and provides resources to connect participants with a provider if needed.

The virtual risk quiz is part of the “Are You the 33%?” initiative focused on reaching, educating, and empowering Hispanic and Black Americans to take control of their kidney health. Since the launch of the campaign in March of 2020, more than 275,000 people have taken the quiz and found out if they are at risk.  About 80% of all quiz respondents are people of color with approximately 35% identifying as Hispanic.  Importantly, 85% of all quiz respondents have at least one risk factor for kidney disease.

However, programmatic solutions alone will not solve systemic and structural issues that impact patients’ health outcomes. The NKF also is dedicated to working with partners who can bridge the gap to the root causes and driving factors that contribute to chronic disease. Access to care, housing and food security, reliable access to transportation, access to affordable prescriptions, eliminating bias while obtaining medical care, and any other inequities that prohibit patients from living their healthiest lives possible are top priorities for the organization. With a coalition of partners, the NKF aims to close the gap among the enumerated disparities—especially in Communities of Color and other marginalized communities—that impact kidney patients from diagnosis, to treatment, to transplantation.

Finally, we are leveraging policy to address many of the gaps that exacerbate inequity in health care.  NKF is a strong supporter of the Health Equity and Accountability Act, which aims to strengthen kidney related research at the National Institutes of Health (NIH), improve access to clinical trials for Black, Indigenous, and people of color, accelerate public health and prevention activities around kidney disease, and expand access to home dialysis. The legislation also includes provisions to address social determinants of health, expand access to affordable and quality health care, strengthen health data collection to inform policies that eradicate racial and ethnic health inequities, and target investments that strengthen the health care system so that it works for everybody.

In order to slow progression of CKD, we need to increase awareness, identify high risk groups, and treat early. We need to avoid inertia in the treatment of CKD and work on preserving kidney function. At NKF we are ready to meet this challenge! Please partner with us to make our programs available to all patients that may benefit from them and to advance policies that allow everyone to have a fair and just opportunity to be as healthy as possible.

– Post prepared by Sylvia E. Rosas @sylviaerosas and Katelyn Laue @Katelynengel

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