Social determinants of racial and socioeconomic disparities in CKD and ESRD

Race and ethnicity imprecisely align with genetic differences based on ancestral origin. Rather, they reflect a complex and interacting mix of social, cultural, and biological factors. While genetic differences clearly contribute to some racial and ethnic disparities, including those in chronic kidney disease (CKD), these disparities are also fueled by the clustering of negative social determinants of health, or social risks, in minority and socially disadvantaged populations. These social risks have clear and strong associations with both CKD and end-stage renal disease (ESRD) and contribute to the substantial disparities that exist in CKD and ESRD across racial, ethnic, and socioeconomic lines. This chapter reviews the socially constructed nature of race and ethnicity, discusses the substantial disparities that exist in CKD and ESRD populations across race, ethnicity, and social class, and describes the role that social risks play in the development of CKD and ESRD and in their disparate impact on low-income and racial/ethnic minority populations.