Hemodialysis in the Elderly African American Population

ESRD incident rates caused by hypertension and diabetes vary across different races and ages in terms of numbers of patients and rates of growth. The rate of diabetes ESRD among Caucasian patients below the age of 40 reached its optimum in the early 1990s. However, the incidence of the disease fell by 46% among the patients aged 20-29 and 13% among the patients of the age group 55-89. On the contrary, the incidence of the disease among the African American population increased by 15% and 47% respectively for the two age groups named above (USRDS, 2006). Since 2000, statistics indicate that ESRD seems to be stabilizing among Caucasian patients. On the other hand, the incidence of the disease has been growing by 26% among African American patients aged 55-89 years.

Elderly African American patients with ESRD

In 2004, statistics stated that African American patients of ESRD aged 50-59 were 911 in a population of a million people, a rate that was 3.2 times higher than the prevalence found in a decade younger patients. A study of the Hispanic population defines that incidence rates were 635 and 166 patients respectively for the two age groups (USRDS, 2006). The analysis of the data on ESRD cases caused by hypertension sshowsthe same differences. For example, in 2004, ESRD African American patients suffering from hypertension for ages 30-39 were 149 patients in a million people. Contrarily, incidence rates among Caucasians were 15 times lower. The high prevalence of the disease among the African American population means the need for better management of hypertension. In addition, the disease divergence on the basis of gender was 1.5 times higher among men in 1994 and has grown by 47% for men and 39% for women.


Prevalence rates are rising continuously in the United States. Since 1980, the annual rate of growth for ESRD is about 1.9%. Statistics show that the cases were higher in urban areas with 343,000 patients reported in the densely populated urban areas (USRDS, 2006). On the other hand, 109,000 patients lived in rural areas. The most affected part of the population includes people aged 75 years and above who constitute 16% of the ESRD patient population. In addition, the rate of growth of prevalence among patients aged 75 and above is higher than 80%. The median age among Caucasians is 59.6 years while among African Americans is 56.4 years.


According to Birkelan et al. (2000), ESRD patients in need of renal replacement therapy through dialysis or transplant are at a high risk of cancer infection. Research shows that ESRD death-related cases that are also connected to kidney cancer could also be related to cardiovascular and other medical conditions either referred to or that cause the kidney disease in question. Specialists carrying out operations on renal tumor patients are required to have a clear understanding of the initial renal health of the patient as well as the potential effect of the operation on the patient.


Statistics present that in the U.S., about 26 million people suffer from chronic kidney disease and are thus exposed to risks of kidney failure. Between 1991 and 2004, the number of patients requiring dialysis and kidney transplant was doubled. Treatment of ERSD poses financial challenges for many patients with its expenses amounting to about $70,000 per patient. The African American population is highly affected by ESRD. In addition, according to statistical data, the African American population requires dialysis and transplant earlier in life than other racial groups.

Behavioral Dimensions

Patterns of kidney failure differ among races with the rate at which CKD progresses to ESRD. Higher rates of progression are closely associated with risk factors like diabetes, obesity, and hypertension. These risk factors do not give an adequate explanation for the high progression among the African American groups and the poor. Social environmental factors influence the rate of CKD progression and the associated complications.


Type 2 diabetes is more than 2.2 times higher in prevalence among African Americans as compared to Caucasians. In addition, hypertension is a critical cause of ESRD among African Americans (Hill, Neighbors, & Gayle, 2004). Gender is an important factor in variations caused by ESRD. Research carried out at the University of Mississippi Medical Center between 1993 and 1998 indicates that Diabetic Nephropathy caused ESRD in 50% of African American women. On the other hand, hypertension was the main cause of ESRD among men. The differences in the causalities of the ESRD condition can be based on increased cases of diabetes and obesity. In addition, studies indicate that African American males are disposed to a higher risk of urine albumin. The modifiable factors that can be used to explain early renal decline include income levels, blood pressure, education, and glucose.

Some factors that have been put across to explain racial differences in diabetes nephropathy cover differences in genes, the severity of hypertension, high rates of obesity, lack of access to education and medical care. Macrosocial factors attempt to offer an explanation for why different social structures produce different rates of crime. The factors that lead to variations in crime rates contain the level of income, residential mobility, and ethnic heterogeneity.


Social stratification is related to a poor social environment with attributes like high rates of substance abuse, joblessness, and single parenthood (Anderson, 1999). Poverty is closely correlated to crimes like murder, robbery, and theft among others. In the United States, 20% of African Americans live in areas with 56 people per 1000 people crime rates (Crook, 2002). Exposure to violence and its associated implications indicate enormous differences in the resultant chronic stress.

Psychosocial Dimensions

Long-term exposure to violence and other crimes because of racial segregation creates chronic stress among individuals in question. Researchers use the concept of allostasis to explain how organisms survive throthrough theelopment of instant hormonal changes in response to environmental changes. Constant exposure to impoverishing conditions and discrimination in violent neighborhoods results in allostatic load conditions (Crook, 2002).


The persistence of the condition over a long period of time affects body systems negatively. Some of its health effects include cardiovascular, hypertension, thrombosis, atherosclerosis, obesity, and type 2 diabetes. The pressure that segregated individuals are exposed to pushes them to have attributes like aggression, frustration, and inability to control anger. They, therefore, easily resort to poor coping choices like substance abuse, which lead to secondary damage to the body’s vital organs like heart, liver, and lungs.


The ESRD affects both the family and the individual psychologically. In most cases, it disrupts normal life thereby requiring careers and family members to be accommodating. The progression to ESRD is associated with stringent restrictions and threats of loss of life. Most dialysis patients face the problem of depression and their minds are filled with suicidal ideas. Patients find it hard to face the effects of their illness and do not see the importance of struggling for minimal chances of existence. Patients suffering from chronic conditions lose their will to live leading to a psychological death and later on physiological demise. Patients undergoing dialysis do not adhere to dietary requirements most of the time. At times, they consider this inconsistency as a way of getting back to the treatment process and the team. Research shows that depression is an important factor that influences a patient’s ability to comply with the prescribed diet. Patients suffering from depression and who do not comply with the dietary regimens are likely to commit suicide or suffer from cardiac arrest.

Environmental Dimensions

According to Levy (1983), survival of dialysis patients is anchored on personal ability to adapt to changes. Dialysis survivors mostly fall into denial and are empathetic to other patients. Among the aged, failure of the process is closely linked to depression, stress related to fear of death, pain during the treatment process, and blood clotting. Financial challenges force most patients to receive their treatment at home. To minimize the rate of mortality among dialysis patients, health care providers should put into consideration the psychological factors that affect survival of the patients both positively and negatively. This will give room for identification of the determinant factors. Thus, early intervention that is likely to enhance a patient’s adaptation to his or her condition is necessary.


The socioeconomic context of an individual’s neighborhood is a determinant of his or her health status. There are perceived relationships between environmental factors and socioeconomic disparities in the state of an individual’s health (Williams & Collins, 2001). Literature shows that residential community characteristics like the quality of housing, economic status, family stability, segregation, unemployment, and political empowerment determine the community’s health outcomes. The community social and economic status determines access to the available amenities, built environment, social norms, or vices and influences individual’s behavior.


A community poses both societal and individual risks to its residents. There are factors that affect the health of all residents regardless of their socioeconomic status. For example, segregation affects even the well-off people as far as they live in the segregated neighborhoods and exposes them to risks like cardiovascular diseases, and diabetes hereby increasing mortality (Williams & Collins, 2001). The socioeconomic environment defines an individual’s ability to access health care. Individuals suffering from chronic diseases as well as financial challenges are not likely to get proper medical care. Among such patients, CKD is likely to progress to ESRD faster than among individuals with access to proper medical care.

Primary Prevention

Underclass societies are exposed to factors like segregation and poverty (Jencks & Susan, 1990). To change the prevalence and incidence of chronic diseases among the disadvantaged population, there should be structural and political changes that deal with the problem of segregation. This will enable the lower status population to access free excellent health care services that are meant for the rich. In addition, the process of individualization should be introduced to teach the poor how to look at problems as a person and not as a society (Williams & Collins, 2001). This will encourage them to take precautionary health initiatives as individuals. Other primary prevention means include education on how to observe health measures and emphasizing preventive methods like immunization. Other measures contain good nutrition and medical check-up to ensure one is in good health and practices physical exercises to maintain fitness.

Secondary Prevention

Among secondary preventive measures one should mention going for medical checkups once he or she suspects mild symptoms of infection. In addition, once diagnosed positively with a kidney condition, the patient should seek for a physician’s consultation and ensure that he or she follows the instructions to achieve full recovery. Early diagnosis of chronic kidney disease is a gateway to successful treatment of ESRD (Krieger et al., 2005).

Tertiary Prevention

Tertiary preventive measures involve the actual treatment of a chronic kidney condition that has progressed in to its late stages. The patient is required to adhere to the doctor’s instructions on dietary regimen, go for counseling to deal with survival threats associated with dialysis patients, and learn to empathize and accommodate fellow patients and family members.

Public Health Policy Implications

In the U.S., racial segregation still exists even after legal codes to abolish it were enacted. Research shows that although residential segregation is ignored, it affects the health status of African Americans in many ways (Sampson, 2003). People living in segregated environments are exposed to unhealthy environments, poor nutrition, inadequate recreational facilities, victimization, and substance abuse. Segregated residents have poor medical care facilities to enhance prevention, diagnosis, treatment, and rehabilitation of patients (Wilson, 1987). The social and physical environmental factors expose the residents to chronic stressors. Accoding to research, segregated African Americans are less likely to receive proper medical care for chronic kidney diseases and ESRD complications because of racism influenced clinical decisions.


So, ESRD prevalence and incidents are higher among the African American population in the U.S. as compared to the Caucasian population. The CKD infection progresses faster to the ESRD stage among the African Americans because of both physical and social environmental stressors they are exposed to. This increases their chances for development of chronic diseases. In their segregated environments, the poor do not have access to adequate medical care, and thus initiation of primary, secondary, and tertiary preventive measures is difficult.


Anderson, E. (1999). Code of the Street: Decency, Violence, and the Moral Life of the Inner City. New York, NY: Norton.

Crook, E. (2002). Diabetic renal disease in African Americans. American Journal of Medical Science, 2(5), 78-84.

Hill, C., Neighbors, H. & Gayle, H. (2004). The relationship between racial discrimination and health for Black Americans: measurement challenges and the realities of coping. African American Research Perspectives, 10(1), 89–98.

Jencks, C. & Susan, E. (1990). The social consequences of growing up in a Poor neighborhood Inner City Poverty in the United States. Washington, DC: National Academy of Sciences.

Krieger, N., Smith, K., Naishadham, D., Hartman, C. & Barbeau E. M. (2005). Experiences of discrimination: validity and reliability of a self-report measure for population health research on racism and health. Social Science and Medicine, 61(7), 1576–1596.

Levy, N. (1983). Psychological problems in kidney failure and their treatment. New York, NY: Plenum Medical Book Company.

Sampson, R. (2003). The neighborhood context of well-being. Perspectives in Biology and Medicine, 46, S53–S64

USRDS (2006). Annual data report: Atlas of end-stage renal disease in the United States. New York, NY: National Institute of Diabetes and Digestive and Kidney Diseases.

Williams, D. & Collins, C. (2001). Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Reports, 116(5): 404–416.

Wilson, W. (1987). The truly disadvantaged: The inner city, the underclass, and public policy. Chicago: University of Chicago Press.

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