Understanding the Link between Neighborhoods and Kidney Disease

Abstract

Neighborhoods are where we live, learn, work, pray, and play. Growing evidence indicates that neighborhoods are an important determinant of health. The built features of our neighborhoods, such as the ways in which the streets are designed and connected and the availability of green spaces and transit stops, as well as the social features, such as the trust among neighbors and the perceptions of safety, may influence health through multiple pathways, such as access to important resources, psychosocial stress, and health behaviors. In particular, the extant literature consistently documents an association between neighborhood features and renal-associated conditions, such as cardiovascular disease, hypertension, diabetes, and obesity. There is also some evidence suggesting an association between neighborhood poverty and ESKD. The link between neighborhood and earlier stages of CKD, however, has been less clear, with most studies documenting no association. It may be that the neighborhood measures used in previous studies do not capture features of the neighborhood important for earlier stages of disease development and progression. It may also be that our current biomarkers (e.g., eGFR) and urine protein are not able to pick up very early forms of renal damage because of the kidney's overall high reserve capacity. This paper critically reviews the state of the literature on neighborhood and renal disease, with recommendations for neighborhood measures in future research. Neighborhoods are designed, built, and informed by policy, and thus, they are amenable to intervention, making them a potentially powerful way to improve renal health and reduce health inequalities at the population level.

Figure 1.

Map of the standardized incidence rate of ESKD by health service area in the US population, 2012–2016. It is standardized to the age-sex-race distribution of the 2011 United States population. Special analyses exclude unknown age, sex, health service area, and unknown/other race. Values for cells with ten or fewer patients are suppressed. The data reported here have been supplied by the US Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy or interpretation of the US Government. Data source: Special analyses, USRDS ESKD Database (61).

Figure 2.

Conceptual model linking neighborhood context to renal pathology. Although not covered in the discussion, others have outlined the link between social, psychologic, and biologic stress and the kidney (62). CVD, cardiovascular disease.