Proposed Mechanisms

The article presents elevated dialysis burden as multifactorial rather than solely due to traditional risk factors. Unmeasured structural and social barriers may contribute to worse kidney outcomes. Lower coronary artery disease rates may increase dialysis prevalence in some groups by improving survival to end-stage renal disease. APOL1 high-risk variants are proposed as a plausible contributor to accelerated CKD progression in Black and Caribbean patients. Assuming diabetes explains all progressive CKD in high-risk communities may obscure non-diabetic kidney disease.