Type 2 Diabetes

What Black Americans With Type 2 Diabetes Need to Know About Chronic Kidney Disease

What Black Americans With Type 2 Diabetes Need to Know About Chronic Kidney Disease
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By
Laurel Leicht
Published on January 28, 2025
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If you have diabetes, you may know that you’re at higher risk of developing heart disease later in life.

 But what you may not realize is that having diabetes can also increase your risk of chronic kidney disease (CKD), in which the kidneys become damaged and lose their ability to filter blood properly.

Black Americans are particularly at risk for CKD. They’re not only 1.3 times as likely to have kidney failure as white Americans, but also nearly twice as likely to develop type 2 diabetes.

What’s the link between the two conditions, exactly? High blood sugar from diabetes can damage blood vessels in the kidneys and tiny filters within them, called nephrons.

 This can happen with both type 1 and type 2 diabetes, says Ivan Porter II, MD, a nephrologist at Mayo Clinic in Jacksonville, Florida. “The fact that the blood glucose is high is what causes the damage,” he says.

Still, diabetes is only one of many factors that can increase the likelihood of developing CKD. Here’s how to monitor your risk and take steps to lower it.

Other Risk Factors for Chronic Kidney Disease

Along with diabetes, there are several health conditions and lifestyle factors that can have an impact on your kidneys and your risk of developing CKD.

 These include:
  • Family history of chronic kidney disease
  • Genetics
  • Heart disease
  • Hypertension, or high blood pressure
  • Obesity
  • Smoking or tobacco use
  • Access to and trust in healthcare
  • Socioeconomic issues
When it comes to genetics, doctors have learned that having a gene called apolipoprotein L1 (APOL1) increases the risk of CKD, and Black people are more likely than other groups to have the gene.

 In a study, having an APOL1 variant was associated with 18 percent higher odds of chronic kidney disease.

Where you live, whether or not you have insurance, and your financial status can also affect your ability to monitor for and treat kidney disease, because these factors have an impact on your access to good doctors, says Dr. Porter. “Do you trust the physician that you see regularly to treat your risk factors?” he asks. “Things that have happened historically affect the way that African Americans interact with and trust in the healthcare system.”

There are also social issues that can increase Black Americans’ risk of kidney disease, many stemming from systemic racism, says Porter. For example, working longer hours or night shifts may lead to a tendency to eat more processed foods or sugary drinks, which increases the risk of obesity and other complications, such as kidney disease, he notes.

Environmental factors also come into play. “Historically, where Black communities have been relegated, [such as] areas that may be near industrial plants … can have environmental factors associated with a higher risk of chronic kidney disease,” says Porter. This may include “lack of access to clean water, which makes them more likely to drink more sugary beverages,” he says. “More empty calories leads to more obesity.”

Signs and Symptoms of Chronic Kidney Disease

“A lot of times, people don’t feel bad with kidney disease until it’s pretty advanced,” says Porter, adding that the first signs of kidney disease are often detected on blood work during a routine physical or urinalysis.

In your routine blood work, your doctor will look at the levels of toxins that your body should be able to clear, including creatinine, a waste product of the digestion of protein in your food and the normal breakdown of muscle tissue. They should also keep an eye out for electrolyte disturbances, he adds, such as elevated potassium or phosphorus. On a urinalysis, they may see albumin (a protein) or abnormal red blood cells.

Other symptoms include:

  • Urinating more often
  • Fatigue
  • Swelling of the hands and feet
  • Dry or itchy skin
  • Issues with the heart or blood pressure
  • Loss of appetite or weight loss
  • Nausea

Tips to Help Prevent CKD

Taking these steps can help protect your kidney health.

Get your annual physical. It’s crucial to have regular checkups to test your kidney function. “You can go to the doctor one time and get labs done, but that doesn’t tell you much,” says Porter. Knowing how your labs trend over time is much more meaningful. “What was this like last year? Or this was elevated this time; if we repeat it in a couple months, will it remain elevated? Those are the things that bring to light the severity of kidney disease,” he notes.

Exercise regularly. There aren’t specific guidelines for how much exercise you need to prevent chronic kidney disease, but the American Diabetes Association recommends that people with diabetes aim for 150 minutes of moderate-intensity activity spread out over a week.

Eat a healthy diet. Avoid processed foods whenever possible, especially foods with high amounts of sodium or phosphorus, which can be hard to filter when kidney function is impaired. It’s often used as a preservative, so avoiding foods like lunch meat, hot dogs, and frozen foods can help reduce your intake.

Stay hydrated. “Ask yourself how many sugar-sweetened beverages or empty calories you’re getting,” says Dr. Porter. “Focus on hydration and healthy beverage choices.” When in doubt, choose water.

Tell your doctor if you’re taking any medications or supplements. Don’t assume that over-the-counter medicines are without risk, says Porter. Common nonsteroidal anti-inflammatories, such as ibuprofen and naproxen, can increase the risk of chronic kidney disease by reducing blood flow to the kidneys, potentially elevating creatinine levels, or affecting kidney function in some people. “Make sure you’re taking the lowest amount of any medication to get the results that you need,” he says.

What Else You Can Do

The most important step you can take to reduce your chances of developing chronic kidney disease is to know your risk factors and discuss them openly and often with your doctors. Routine monitoring with regular blood work and urinalyses are crucial for keeping an eye on any changes, says Porter.

“Your doctor has to be looking for those things to spot abnormalities and then optimize your risk factors,” he says. “That’s when they help you decide if you need to see a kidney specialist or where exactly you should concentrate your prevention efforts.”

The Takeaway

  • Black Americans are more likely than other populations to have chronic kidney disease and type 2 diabetes.
  • While some of the increased risk of CKD may be genetic, other factors include socioeconomic issues, such as access to doctors and healthcare services.
  • Regular monitoring can help spot kidney problems in the earlier stages of the disease.
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igor-kagan-bio

Igor Kagan, MD

Medical Reviewer

Igor Kagan, MD, is an an assistant clinical professor at UCLA. He spends the majority of his time seeing patients in various settings, such as outpatient clinics, inpatient rounds, and dialysis units. He is also the associate program director for the General Nephrology Fellowship and teaches medical students, residents, and fellows. His clinical interests include general nephrology, chronic kidney disease, dialysis (home and in-center), hypertension, and glomerulonephritis, among others. He is also interested in electronic medical record optimization and services as a physician informaticist.

A native of Los Angeles, he graduated cum laude from the University of California in Los Angeles (UCLA) with a bachelor's in business and economics, and was inducted into the Phi Beta Kappa honor society. He then went to the Keck School of Medicine at the University of Southern California (USC) for his medical school education. He stayed at USC for his training and completed his internship and internal medicine residency at the historic Los Angeles County and USC General Hospital. Following his internal medicine residency, Kagan went across town to UCLA's David Geffen School of Medicine for his fellowship in nephrology and training at the UCLA Ronald Reagan Medical Center. After his fellowship he stayed on as faculty at UCLA Health.

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Laurel Leicht

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Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
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