What are the contributing factors to the high prevalence of renal (kidney) failure in the Southeastern United States, including dietary and lifestyle habits, and how do compliance and cultural factors impact patient outcomes?

From the Guidelines

Renal failure in the Southeastern United States is primarily driven by a combination of dietary habits, lifestyle factors, and cultural influences, which can be effectively addressed through culturally tailored education, community-based interventions, and simplified medication regimens. The traditional Southern diet, characterized by high sodium content, excessive animal protein, and processed foods, directly contributes to kidney damage over time, as noted in a study published in the American Journal of Kidney Diseases 1. Foods like fried chicken, biscuits with gravy, sweet tea, and processed meats are dietary staples that deliver excessive sodium, phosphorus, and protein loads that stress kidney function. Additionally, the widespread consumption of sugar-sweetened beverages, particularly sweet tea, contributes to obesity and diabetes, both significant risk factors for kidney disease.

Contributing Factors to Renal Failure

• Dietary habits: high sodium content, excessive animal protein, and processed foods
• Lifestyle factors: physical inactivity, smoking, and limited access to healthcare
• Cultural influences: traditional dietary preferences, distrust of healthcare systems, and stoicism and self-reliance values
• Socioeconomic factors: higher poverty rates and lower educational attainment, creating barriers to healthy food access and medical care

Impact of Compliance and Cultural Factors on Patient Outcomes

• Medication compliance: poor adherence due to financial constraints, health literacy limitations, and side effect concerns
• Cultural barriers to compliance: traditional dietary preferences, distrust of healthcare systems, and stoicism and self-reliance values
• Successful approaches: culturally tailored education, community-based interventions, and simplified medication regimens, as suggested by a study published in Kidney International 1

Recommendations for Healthcare Providers

• Recognize regional and cultural factors when developing treatment plans
• Implement culturally tailored education that respects traditional foods while suggesting healthier preparation methods
• Leverage community-based interventions and trusted local institutions to promote health education and support networks
• Simplify medication regimens to account for financial and practical constraints, as recommended by a consensus report by the American Diabetes Association and Kidney Disease: Improving Global Outcomes 1
• Utilize telehealth initiatives to overcome geographic barriers to specialist care and interdisciplinary care teams to address social determinants of health.

From the Research

Contributing Factors to Renal Failure in the Southeastern United States

• Socioeconomic disparities, including access to quality care and economic factors, play a significant role in the high prevalence of renal failure in the Southeastern United States 2
• Racial and ethnic disparities, with African Americans being 3 times more likely to require renal replacement therapy than their non-Hispanic white counterparts, also contribute to the high prevalence of renal failure in the region 3
• Geographic heterogeneity, including the effects of socioeconomic, racial, and morbidity-related factors, varies significantly over space and has a strong impact on end-stage renal disease prevalence in the Southeastern states 4

Dietary and Lifestyle Habits

• Obesity, diabetes, and binge drinking prevalence have been identified as behavioral risk factors that contribute to the high prevalence of renal failure in the Southeastern United States 4
• The metabolic syndrome, which includes factors such as diabetes and hypertension, is a principal factor responsible for the epidemic of chronic renal insufficiency 5

Compliance and Cultural Factors

• Cultural and environmental determinants of health, which are influenced by socioeconomic constellations, can affect complex medical disorders such as renal failure 2
• Compliance with treatment and management of renal failure can be impacted by cultural factors, including access to quality care and patient education 3
• Reducing kidney disease incidence will positively impact US health disparities, and increasing research investment will identify, develop, and increase implementation of interventions to slow kidney disease progression, reduce incidence of kidney failure, enhance survival, and improve quality of life 6