Structural inequalities and chronic disease health outcomes: Chronic kidney disease

Despite advances in medical care and a growing understanding of Chronic kidney disease (CKD) biological mechanisms, stark disparities persist in its prevalence, progression, treatment, and outcomes across racial, ethnic, and socioeconomic groups. These disparities reflect a complex interplay of social, environmental, and biological factors that are not fully understood. This chapter provides an overview of CKD including definitions, diagnosis, and staging. The spectrum of CKD care is presented, with prevenance and disparities in burden across this spectrum detailed. Several conceptual models and frameworks from the field are presented to illustrate and discuss contributing factors to disparities in CKD and the role of structural inequalities while summarizing the evidence across domains of social determinants of health. This chapter concludes by identifying and discussing gaps in knowledge. Application and a path forward are summarized that include steps to effectively address structural inequalities through intentionality and multidisciplinary approaches that apply existing strategies used across disease conditions and working collaboratively to develop and deploy new targeted strategies that are evidence-driven.