Race & Risk for ESRD

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See if you can answer this True or False question:  The increased risk of ESRD in African-Americans is due to the increased risk of hypertension and diabetes seen in this population.  

I think the prevailing view in the past was that this statement is true.  However, according to newer data as described in this month’s NephSAP on CKD, the current view is likely FALSE!  
How so?  For one, a 2007 JASN-published longitudinal study looking at the development of ESRD in a cohort of Medicare beneficiaries by Xue et al.  Overall, African-Americans had about 1.5 times the risk of whites of developing ESRD.  However, the subgroup in which there was the GREATEST increased risk of developing ESRD in African-Americans compared to whites was the group in which there was no diagnosis of diabetes nor hypertension (about 3.5 times as likely to develop ESRD).  Thus while hypertension & diabetes are still the leading causes of ESRD overall, these two diseases do not account for all the racial proclivities for developing ESRD.
The NephSAP summary describes other phenomena which may account for such racial dfiferences.  For instance, living in a neighborhood with a high poverty rate has been shown to increase the risk of ESRD; it is speculated that this may account for some of the increased risk of ESRD in African-Americans.   Recent work identifying polymorphisms in the MYH9 gene may provide a genetic explanation for the increased ESRD risk.  Finally, although not a leading cause of ESRD, HIV Nephropathy often pursues a much more aggressive course of African-American patients compared to their white counterparts.  

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