The kidneys sit just below the rib cage, on each side of your spine. Their functions: filter blood to remove waste and extra water. But when they are damaged, the body loses the ability to filter blood, leading to a buildup of waste and fluid — something called chronic kidney disease (CKD). When left untreated, kidney failure can occur, which is when kidneys completely stop working.
But what leads to damage in the kidneys isn’t a pure question of biology — social factors interact, too.
“The fact that your zip code can affect how long you live or how healthy you are really stood out to me as I first began to explore a career in public health. And of course, race plays a part in that as well,” shares Valerie Nwanji, MD, a fellow in Penn’s Renal-Electrolyte and Hypertension division.
While one in three adults in the United States are at risk for kidney disease, that rate increases dramatically for people of color. For example, while Black people make up about 13 percent of the United States population, they represent 35 percent of Americans with kidney failure.
“Unfortunately, people of color are disproportionately affected by kidney disease, in part due to high rates of diabetes and high blood pressure,” said Yuvaram Reddy, MBBS, MPH, an assistant professor of Medicine and the director for Diversity Equity and Inclusion (DEI) in the Renal-Electrolyte and Hypertension division. “Black patients are 31 percent less likely to receive home dialysis, and 12 percent less likely to be on the waiting list for a kidney transplantation, compared to white patients.”
On top of these inequities, patients of color can experience noted detrimental impacts when the people providing their health care are non-diverse — including risks of undermining trust and patient health. But when a workforce better represents the diversity of the patient population they care for, the outcomes are tremendously improved.
Reddy and the Renal-Electrolyte & Hypertension division have taken this to heart. Throughout the past few years, they created pathways to support and celebrate underrepresented staff, nurses, patients, trainees, and physicians — with the hopes of advancing health equity in kidney disease.
“We envision a future where clinicians partner with patients to overcome inequalities, so every patient with kidney disease can receive the same high-quality care,” said Reddy. “And this work starts by focusing on what we can improve internally as a team.”
As part of these efforts, the division created a first-of-its-kind fellowship for trainees — a chief DEI fellowship. Nwanji is the inaugural chief DEI fellow.
“To have a division focused on DEI is fantastic — it’s a great start for an organization. But a fellow role also creates an opportunity to have more of an impact on the Renal division,” Nwanji said.
Nwanji notes her interest in health equity grew as an undergraduate student studying public health at Johns Hopkins University.
Through medical school, she was able to combine her passion for public health and medicine, working her way into a career as a nephrologist with an eye towards closing the racial gaps in health care.
While a resident at Penn State Hershey, Nwanji learned about the fellowship program at Penn, and eventually interviewed with nephrologist Nwamaka Eneanya, MD, MPH, previously an assistant professor of Medicine and Epidemiology and the first DEI director in Renal-Electrolyte and Hypertension at Penn, now with Fresenius Medical Care. Eneanya is known for her work towards eliminating race from a kidney function equation called the eGFR, which research has shown was preventing Black patients from getting the care they need. Nwanji now works closely with Reddy on DEI efforts within the division.
“Penn has been the best place for learning about the potential disparities patients face and how we can best help our patients — not only with an illness itself, but the social aspects of it,” Nwanji says.
And as chief DEI fellow, she is now leading the charge with Reddy on improving the recruitment of minority trainees to the fellowship program, while implementing a DEI curriculum that includes a journal club and patient panel discussions centered on diversity and the elimination of race-based medicine. Additionally, Nwanji is leading health equity research and quality improvement projects focused on alleviating perceptions of racism that may improve access to CKD education and referral to transplantation so that patients receive the health care and treatments they deserve.
It doesn’t stop there. Now, not only does the Renal division have a chief DEI Fellow, but two other groups across Penn have created a similar DEI-track for their fellows: Endocrinology and Pulmonary and Critical Care. All five DEI-track fellows meet monthly to review their health equity projects and develop leadership skills in DEI. Reddy and Nwanji aim to expand this DEI chief fellowship track further, both within and outside Penn. Currently, they are building a concept map of the DEI chief fellowship to help show programs what tools and support DEI chief fellows need to thrive in their role.
“I hope that we’re able to show that this role is needed within the division, and that other departments and specialties will see the value of this work and even include it in their departments,” Nwanji says. “If other departments can implement their own chief DEI fellows, they’ll be able to better focus on assisting patients who face health inequalities.”