Time to Repair the Effects of Racism on Kidney Health Inequity

Elsevier, American Journal of Kidney Diseases, 2021, ISSN 0272-6386,
Authors: 
Dinushika Mohottige, MD, MPH; Clarissa J. Diamantidis, MD, MHS; Keith C. Norris, MD, PhD; L. and Ebony Boulware, MD, MPH

Kidney disease continues to manifest stark U.S. racial inequities, revealing the entrenchment of racism and bias within multiple facets of society including in our institutions, practices, norms, and beliefs. In this perspective, we synthesize theory and evidence to describe why an understanding of race and racism is integral to kidney care, providing examples of how kidney health disparities manifest interpersonal and structural racism. We then describe racialized medicine and color-blind approaches as well as their pitfalls, offering in their place suggestions to embed anti-racism and equity lens into our practice. We propose examples of how we can enhance kidney health equity by enhancing our structural competency, equity-focused race consciousness, and by centering investigation and solutions around the needs of the most marginalized. To achieve equitable outcomes for all, our medical institutions must embed anti-racism and equity into all aspects of advocacy, policy, patient/community engagement, educational efforts, and clinical care processes. Organizations engaged in kidney care should commit to promoting structural equity and eliminating potential sources of bias across referral practices, guidelines, research agendas, and in clinical care. Kidney care providers should reaffirm our commitment to structurally competent patient care and educational endeavors in which empathy and continuous self-education about social drivers of health and inequity, racism, and bias are integral. We envision a future in which kidney health equity is a reality for all. Through bold collective and sustained investment, we can achieve this critical goal.