Lessons from chronic renal diseases in African Americans: treatment implications

End-stage renal disease (ESRD) is a significant public health problem in both developed and developing countries. The magnitude and patterns of renal disease vary among countries, differences that could be due, in part, to regional racial and ethnic composition. The United States is a typical example, with significant racial and ethnic differences in the magnitude and pattern of renal disease. Compared with Caucasians and Asians, African Americans, Native Americans, and Pacific Islanders are disproportionately afflicted with end-stage kidney failure. Whereas diabetes mellitus (primarily type 2) is the predominant cause of renal disease (and ESRD) in the United States, especially in Native Americans, hypertensive kidney disease is a major cause of ESRD in African Americans. Some of the lifestyle and physical characteristics that may be responsible for the increased incidence and prevalence of hypertensive kidney disease in African Americans include: 1) the higher prevalence and severity of hypertension, especially in the early years of life; 2) lower socioeconomic status leading to inadequate health care; 3) a greater propensity toward developing intrinsic renal vascular disease; 4) a greater tendency toward developing target organ damage at "normal" blood pressure levels; 5) illicit drug use; and 6) the use of medication that is less reno-protective to treat their blood pressure.