End Stage Renal Disease: Racial Differences

Objectives: The prevalence and aetiological of end stage renal disease (ESRD) differ from race to race and from location to location even among people of the same race. There is paucity of data on the comparison of ESDR in whites and blacks living in their native environment. The study was undertaken to retrospectively define the differences in manifestation of ESRD in whites and blacks in their natural environment. Methods: Case records of consecutive patients in chronic renal failure that were seen at the University of Ilorin Teaching Hospital, Ilorin, Nigeria and Guy's Hospital, London, England over a four year (1996 to 1999) and two year periods respectively were reviewed. Data collected included data on sex, age, race, aetiology and usual features of ESRD. Results: A total of 127 blacks (76 males, 51 females) and 125 Caucasians (74 males, 51 females) were recruited and categorized into groups. The commonest disease causing ESRD in Caucasians was diabetic nephropathy [(DN), 26.4%] followed by chronic glomerulonephritis [(CGN), 16.8%] and hypertensive nephrosclerosis [(HTN), 10.6%]. Amongst blacks, however, CGN (38.6%) was the commonest cause, followed by HTN (26%) and DN (7.05%). In 14% and 9% of blacks and whites respectively, the cause of ESRD was unknown. Most blacks with CGN and HTN reached ESRD in the 2nd and 3rd decades; in any case earlier than whites. DN was thrice commoner in whites with the majority in the 5th and 6th decades in both races. Conclusion: This study tends to validate the notion that the spectrum of renal diseases in the tropics is generally the same as in the temperate environments, but the prevalence, natural history and major Aetiological factors do vary from race to race and in location. Diabetic nephropathy which was thought to be rare in blacks is becoming a major problem. It is disturbing that a high proportion of blacks reached ESRD within their 2nd to 4th decades when they are still very productive. Key Words: ESRD, Race, Prevalence, Aetiology Orient Journal of Medicine Vol.15(1&2) 2003: 24-31