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Social Determinants of Health and Chronic Kidney Disease

People develop chronic kidney disease (CKD) due to a number of reasons and there are many things that can increase your chances of getting it. Some of these things are medical, like having high blood pressure or diabetes.

Environmental factors can also play a part. For instance, breathing in dirty air can hurt our lungs, while drinking contaminated water can cause stomach infections. 

In addition, there are social factors, which are things like how much money we have, our education level, and our relationships with family and friends can affect our health. Discrimination and not having access to healthcare can also increase the risk of developing CKD.

For many, the risk of developing chronic kidney disease is not because of any one single reason, but due to a number of medical, environmental, and social factors.

Social determinants of health

According to the US Department of Health and Human Services, Office of Disease Prevention and Health Promotion report, Healthy People 2030, social determinants of health (SDoH) are the conditions in the environments, such as where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

For example, if you are not able to buy healthy food at a store near you, then it will be hard for you to eat well. People who are unable to eat healthy foods are more likely to develop serious health conditions, like heart disease, diabetes, CKD, and obesity.

All of Us Research Program, National Institutes of Health, US Department of Health & Human services, Social determinants of health, Twitter, June 1, 2022. Accessed May 10, 2023.

SDoH are the nonmedical factors that can make it harder for you to be healthy and get the medical care and support you need. Some of the ways SDoH can affect you and your family include:

Food Security

Sometimes a family goes through tough times due to job loss or illness. Family members may feel sad or worried about having enough money to buy food. During these hard times, there may not be enough food for the family to eat or to know when they'll have their next meal.

Since John has been laid off, he and his wife, Bernice, are having a hard time making ends meet on just her wages. Sometimes, they have to decide whether to pay for gas for their car so Bernice can go to work or buy enough food to feed themselves and their two children. Sometimes, John and Bernice skip their own meals to make sure their children are eating.

Housing stability

People face bad times when there is not enough money to get the things they need, which can lead to feeling worried and sad. Not having enough money can make it hard to pay rent, have enough space to live in, or the stability of living in one place for a long time. You might need to stay with other family members or spend most of your money on rent.

Maria has moved five times in the past year because she couldn't afford the increases in her rent. Now, she's couch-surfing with friends until she can find an affordable place to live.

Transportation access

When you do not have access to affordable, convenient, reliable transportation, it is hard to get places, including, school, daycare, grocery stores, medical appointments, and more.

Amir is 67 years old and has kidney failure. He needs dialysis 4 times a week to survive — but there is no public transportation near where he lives, and the closest dialysis center or hospital is 20 miles away.


People can be worried about violence happening in their homes or neighborhood, like being hurt themselves, seeing someone else get hurt, or being a victim of a crime.

After being physically assaulted and robbed on her way home from work, Nicole is scared and anxious every time she walks alone at night and has started taking a longer route home to avoid dark streets.

Basic utilities

Sometimes people don't have water, electricity, phone service, internet, WIFI, or gas in their homes, which means they might not have working refrigerators, stoves, or ovens, heat in cold winter months, or running water for showers and toilets.

Since her parents couldn't afford to pay their utility bills, the apartment that Sonya and her family lived in didn't have running water or electricity, and they had to visit public bathrooms and use candles for light.

Access to education

In some areas of the country, especially urban and rural areas, many people do not have the access or the money to go to good public schools or attend college and trade schools to learn skills needed for well-paying jobs.

Dasan lives in a neighborhood that does not have access to good schools, books, or computers. They want to become a nurse but do not have money for school. They will have to go to work right after they graduate high school to help support their family.

SDoH and CKD

It is important to understand how factors like where you live and whether you can get quality medical care when needed can affect your health. For example, if you are pregnant and unable to get good prenatal care, you can develop eclampsia (a type of high blood pressure that can occur during pregnancy and cause seizures – which can be life-threatening to both baby and mom) and other conditions. Eclampsia can also lead to long-term kidney damage. 

Sometimes people don't know they have chronic kidney disease (CKD) until the disease has advanced. This is because there are very few symptoms in the early stages of CKD.

If you don't have access to healthcare or transportation, it can take even longer to find out if something is wrong with your kidneys. 

That’s why it’s a good idea for people who are at risk for CKD to get regular tests to check how well your kidneys are working.

CKD risk factors

SDoH can contribute to developing serious chronic conditions such as high blood pressure, diabetes (also called sugar diabetes or sugar disease), lupus nephritis, or being overweight – all conditions that increase your risk of developing CKD. In addition, your genetics or having family members with CKD may also play a role.

It’s not always easy to be healthy or have a healthy lifestyle. And why is that? Well—the short answer is that many people, especially people living, working, and learning in under-resourced communities, simply do not have access to the very basics that are needed, such as open and green spaces like parks, reliable public transportation, healthy foods to eat, and access to appropriate medical care.

Other reasons include not having health insurance, not having a regular doctor who knows you and your medical history, and local healthcare and policy issues, which may not provide a clear path for patients to follow.

Race and CKD

Over 37 million adults in the United States have CKD – and the people who are most at risk self-identify their race as:

  • Black/African American
  • Hispanic/Latino
  • American Indian/Alaska Native
  • Asian American
  • Native Hawaiian/Other Pacific Islander
  • Biracial
  • Multiracial

Some racial groups have a higher risk of developing CKD than others – but their increased risk is not due to their race.

The reason why some people are at higher risk of developing CKD is due to the SDoH caused by race-based social, economic, and political decisions that were made decades ago. These unfair decisions have impacted many urban and rural areas throughout the US.

Restricting investment opportunities for generational success in communities of color made it hard for these neighborhoods to prosper and thrive. Continuing to limit financial, political, and environmental resources contribute to the inequalities and inequities that still exist in these communities today, which is why so people many living in these communities do not have access to well-resourced schools, well-paying jobs, safe neighborhoods, open green spaces, healthy food options, and access to necessary medical care.

These health inequities must be addressed, corrected and require a long-term commitment and more than one approach. We can start with community partnerships and sharing information that is thoughtful, meaningful, and culturally sensitive. Let’s can keep our enthusiasm high, be supportive leaders of change, and empower all community members to help take steps to manage their health better to improve lives.

Questions about CKD

Call toll-free at 855.NKF.CARES (855.653.2273) or email

We speak English and Spanish and are available Monday - Friday from 9:00 am - 7:00 pm Eastern Time.


This content is provided for informational use only and is not intended as medical advice or as a substitute for the medical advice of a healthcare professional.

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