Risk factors for the development and progression of renal diseases in disadvantaged populations: role of the renin-angiotensin system blockade.

Chronic kidney disease is becoming a public health challenge due to the high risk of progression to end-stage kidney disease, the increased cardiovascular burden and management costs, especially among disadvantaged communities. Although the high prevalence of hypertension and diabetes in these populations are recognized risk factors and a leading cause of chronic kidney disease, ethnic populations show a greater likelihood of developing end-stage kidney disease regardless of these cardiovascular risk factors. The association between low socioeconomic status and the prevalence/progression of chronic kidney disease observed in population-based studies suggests that socioeconomic disadvantage could be a plausible reason for the increased burden of renal disease among minorities. Interventions for management and prevention of chronic kidney disease include angiotensin converting enzyme inhibitors and angiotensin receptor blockers. Few studies of these agents have been conducted in indigenous populations, but there is evidence that angiotensin converting enzyme inhibitors are effective in reducing premature deaths and progression of chronic kidney disease, as well as being highly cost-effective, especially in terms of renal replacement therapies avoided. It is plausible that these disadvantaged groups may benefit more than others from a renal and cardiovascular prevention program, but considerable under-recognition and under-treatment of these conditions still exist.