Editorial

I am grateful to the previous editors of Advances in Renal Replacement Therapy, Allen Nissenson and James Winchester, for establishing an editorial legacy that has resulted in a unique, peer-reviewed thematic kidney journal providing superb, focused, scholarly reviews for the kidney community from a multidisciplinary viewpoint. Over the past few years, the journal has broadened its focus to present themes of interest to the entire kidney community, including aging and the kidney, The Acute Dialysis Quality Initiative, gender and kidney disease, and disaster management. Over the next few months, the editors and editorial board will be reviewing the content and focus of the journal to ensure that it is even more relevant to current practice.

You will see some changes in the journal. Some will be evident with the first issue: instead of assistant and associate editors, there are now 13 section editors who will contribute or recruit articles when the issue theme is relevant to their area. The sections include history, basic science, epidemiology and outcomes, technology, nursing, social work, nutrition, pediatrics, transplantation, continuing education, ethics, public policy, and literature review/book review. The editorial board is smaller with a mix of senior and more junior members—my hope is that the senior members will mentor the more junior and that our younger colleagues will provide enthusiasm and new ideas in addition to their clinical and editorial expertise! Beginning with this issue, all issues of Advances in Renal Replacement Therapy will be available in full-text online. They will be free to all until the April 2004 issue is published and free with your print subscription after that. There will be additional changes with the second issue that I leave to your imagination.

John M. Flack, MD, MPH, Errol Crook, MD, and Michael Klag, MD, MPH, edited this first issue, “Racial and Ethnic Disparities in Kidney Disease”. It is an extremely timely and important topic, and I thank them for their hard work. The Institute of Medicine highlighted the tremendous disparities in health care in the United States in a March 2002 report, “Unequal Treatment: What Healthcare Providers Need To Know About Racial And Ethnic Disparities In Healthcare”. The full report was published in 2003.1

Roget’s II: The New Thesaurus, Third Edition (1995) defines disparity as “The condition of being unlike or dissimilar: difference, discrepance, discrepancy, dissimilarity, dissimilitude, distinction, divarication, divergence, divergency, unlikeness. A marked lack of correspondence or agreement: difference, disagreement, discrepance, discrepancy, gap, incompatibility, incongruity, inconsistency. The condition or fact of being unequal, as in age, rank, or degree: disproportion, disproportionateness, inequality.”

The Institute of Medicine report concluded that, “(al)though myriad sources contribute to these disparities [in healthcare for minorities], some evidence suggests that bias, prejudice and stereotyping on the part of healthcare providers may contribute to differences in care.”

How is this relevant to health care professionals working with kidney patients? First, we must understand racial and ethnic differences in incidence and risk factors and ethnic differences in response to therapy. We must also be sensitive to cultural diversity and our personal responses to enriching differences that we may perceive as disparities.

In this issue of Advances in Renal Replacement Therapy, “Racial and Ethnic Disparities in Kidney Disease”, Dr Li et al describe differences in end-stage renal disease incidence between blacks and whites and examines associated risk factors. Dr Lopes explores the relationship between chronic kidney disease progression and racial and ethnic factors. Drs Lakkis and Weir, writing about possible ethnic differences in response to pharmacological treatment of chronic kidney disease, conclude that “the best available evidence from the existing clinical trial database should be applied to minorities with chronic kidney disease—even when specific data are not available for a specific racial or ethnic group.” Dr Hall and colleagues consider the impact of obesity as a cause of chronic kidney disease. There are differences in access to kidney transplantation and response to immunosuppressive therapy; Dr Isaacs discusses the ethical implication. Two articles, one by Dr Hostetter and another by Drs Stevens and Levin, look at research opportunities for eliminating racial disparities in chronic kidney disease management and treatment.

Our section editors have provided articles that discuss nutrition (Dr Burrowes), nursing (Drs Nardi and Rooda), and social work (Ms Root) approaches for ethnically diverse populations. The appropriate expectation is to tailor our approach to each patient rather than expecting the patient to conform. Drs Swift and MacGregor provide an excellent basic science review of genetic variation in the epithelial sodium channel, Dr Andreoli describes racial and ethnic differences in focal glomerulosclerosis in children, and Dr Coney, the non-nephrologist, OB/Gyn Dean of Meharry Medical College, provides a snapshot of racial differences in kidney disease in Tennessee and issues a challenge for the vision and leadership necessary to change a fragmented health care system and eliminate all disparities in health care. I hope you enjoy reading this issue as much as I did and accept Dr Coney’s challenge.

Finally, I would like to thank Dr Linda Hare, the managing editor of Advances in Renal Replacement Therapy, for her tireless effort in helping me to pull this issue together. As many of you know, all this happened as I moved from St. Louis to Nashville, and I couldn’t have coped without her skill and support. I would also like to thank the editorial team at Elsevier Inc. for their vision and openness to change as we move the journal forward in the 21st century.