Maya Clark Cutaia, PhD, RN, is the inaugural Evelyn Lauder Associate Dean for Nurse Practitioner Programs and Professor at the Hunter-Bellevue School of Nursing at Hunter College.

Maya Clark Cutaia, PhD, RN

Neighborhood Disadvantage and Its Downstream Effects on Equitable Kidney Care, With Maya Clark Cutaia, PhD, RN

Neighborhood disadvantage creates barriers to kidney care at every stage of the continuum, from chronic kidney disease (CKD) diagnosis to disease progression to kidney failure requiring transplantation.

 is a place-based measure, defined as 1/5th of a population living below the federal poverty line, and with indices such as the Area Deprivation Index (ADI). Measurable data from the US Census Bureau identified 24 million Americans living in disadvantaged neighborhoods, with a disproportionate amount of racial and ethnic families residing within these communities. For example, only 4.3% of white Americans live in a disadvantaged neighborhood compared to 20.9% of black Americans.

“Unfortunately, for many of the patients that I come in contact with that are facing, you know, access barriers they present far later than I'd like, often after years of silent disease and silent decline, because that earlier phase of chronic kidney disease, which is typically asymptomatic… the screening and follow up may be inconsistent, or, in a lot of cases, non existent,” said Maya Clark Cutaia, PhD, RN, inaugural Evelyn Lauder Associate Dean for Nurse Practitioner Programs and Professor at Hunter-Bellevue School of Nursing at Hunter College.

Clark highlights how subtle clinical biases can compound the problem, influencing who receives close monitoring, early counseling, and timely nephrology referral. These gaps accumulate over time, allowing CKD to advance before intervention begins.

Even for patients who reach advanced disease, geography remains a significant barrier. Clark Cutaia points out that some patients travel 6 to 8 hours to reach a transplant center, an unsustainable burden for those who are working, caregiving, or managing multiple conditions. Transplant programs often assume resources and support structures that simply don't reflect the realities of disadvantaged communities.

“Recognizing, yes, I now have a person who's in a disenfranchised neighborhood. I should be trying even harder to get some of that… preemptive care screening available to them so that they don't end up having the same outcome… doing some of these referrals sooner, the handoff sooner, getting them connected with resources, sooner, as opposed to waiting for us to have, you know, a negative outcome, or for these patients to become symptomatic, because we know that that is going to likely be their end game."

social and neighborhood context into every CKD care

 plan is now a core clinical competency for anyone committed to equitable kidney care.

Editor’s Note: Clark Cutaia reports no relevant disclosures.

Christie-Mizell CA. Neighborhood Disadvantage and Poor Health: The Consequences of Race, Gender, and Age among Young Adults. 

International Journal of Environmental Research and Public Health

Li Y, Menon G, Kim B, et al. Residential Neighborhood Disadvantage and Access to Kidney Transplantation. 

https://doi.org/10.1001/jamanetworkopen.2025.49679

Videos

An expert breaks down how poverty, limited healthcare access, and geographic barriers delay CKD diagnosis, reduce transplant access, and widen health disparities, and what clinicians can do about it.


Neighborhood Disadvantage As a Clinical Variable For Kidney Care, With Maya Clark Cutaia, PhD, RN

Considering neighborhood disadvantage as a clinical variable may be a useful strategy for supporting populations with reduced socioeconomic status in their kidney health, especially 

Lifelong exposure to adverse conditions within disadvantaged neighborhoods has been associated with an increased risk for kidney disease, along with accelerated progression. Despite this population’s adverse clinical outcomes, including progression to end-stage kidney disease, many needs remain unmet.

“In kidney disease, it looks like individuals who have higher exposure to environmental stressors,” said Maya Clark Cutaia, PhD, RN, the inaugural Evelyn Lauder Associate Dean for Nurse Practitioner Programs and Professor at the Hunter-Bellevue School of Nursing at Hunter College, in an interview with 

 “That may be things like pollution and heat, which we're seeing a lot nowadays, when, you know, focusing on climate work, fewer safe spaces so there's an inability to exercise, there's less reliability for access to healthy food and transportation, and then there's just a litany of other barriers that make it difficult for patients to get to primary care or nephrology care, and so it increases their risk, and therefore can accelerate their progression.”

Patients with kidney failure living in disadvantaged neighborhoods face barriers to care. Recent research has reported an association with neighborhood disadvantage and access to waitlisting and kidney transplantation. Furthermore, other evidence stated for > 1 in 10 of the most disadvantaged communities (11.7%) lacked a dialysis facility within a 30-minute drive compared with roughly 1 in 40 of the least disadvantaged communities (2.3%).

Even before patients reach ESKD, there may be missed opportunities for identifying CKD in its earlier stages and to intervene sooner, an aspect especially heightened in this patient population because of the aforementioned barriers to care.

“When we think about neighborhood disadvantage, it does mean there are differences in screening and CKD development or acknowledgement, diagnosis and management, suggesting that there are missed opportunities happening way downstream. It's a difficult conundrum because we're often seeing them being diagnosed at a point when complications already exist, and so our window for intervention is smaller.”

Surachman A. Neighborhood Deprivation, Financial Hardship, and Decrements in Kidney Function Across a Decade. 

https://doi.org/10.1093/geroni/igaf122.4413

Eisenbeisz ME, Chertow GM. Diminished Access to Dialysis in Disadvantaged Communities—Driving Toward More Equitable Care. 

. Published online February 23, 2026. doi:

https://doi.org/10.1001/jamainternmed.2025.8037

Should clinicians consider neighborhood disadvantage the same way they measure proteinuria and GFR for kidney health?

Crisis Point: The Cause and Calamity, Neighborhood Disadvantage and Kidney Disease

Clinicians often think of healthcare as having a problem and a solution, but what if there was more going on underneath the surface?

When it comes to the rising threat of developing 

, there's more at stake than the values we can measure in a lab. This Crisis Point focuses on the detrimental problem of neighborhood disadvantage as the cause and the calamity of kidney disease.

Neighborhood disadvantage is a place-based measure, defined as 1/5th of a population living below the federal poverty line, and with indices such as the Area Deprivation Index (ADI). Measurable data from the US Census Bureau identified 24 million Americans living in disadvantaged neighborhoods, with a disproportionate amount of racial and ethnic families residing within these communities. For example, only 4.3% of white Americans live in a disadvantaged neighborhood compared to 20.9% of black Americans.

These inequities don’t just present through poverty, housing instability, educational opportunities, employment, and access to resources. Neighborhood disadvantage trickles down the line, impacting an individual’s health through daily exposure to unfavorable conditions, including processed food, air pollution, and dehydration. As a result, the pathways to exposure to kidney disease can be represented by acute kidney injury (AKI), with repeated episodes accelerating CKD progression, and they can also be chronic, causing slow debilitating decline over the years.

“I really think that it asks nephrologists and other care providers to treat an individual's social context as part of their care plan,” said Maya Clark Cutaia, PhD, RN, in an interview with 

“We all walk in every day with those things on our backs. You may not see it, but we walk in with our history, our culture, our trauma, you know, our joys, whatever. And if we can take those real-world contexts and apply them to what we want to do next. It'll inform how we treat a patient.”

Statistically, 18.8 to 40 million Americans live within food deserts, characterized by a reliance on gas stations and convenience stores, limited or no access to fresh fruits and vegetables, and poor transportation options and unsafe spaces for exercise.

Having limited access to nutrient-dense options can take a major toll on kidney health. Often, the most affordable and easy choices in disadvantaged neighborhoods are chips, fried food, and sodas, of which the additives and high-sugar levels can build in the kidneys and contribute to inflammation. This differentiates from nephrologists’ kidney-friendly diet recommendations, which are a plant-based protein diet focused on whole foods and vegetables, while taking into account the risk of muscle loss for patients on dialysis.

Previous research has linked food deserts and disadvantaged communities with an increased risk of obesity. In kidney disease, obesity has been seen as both a 

 of further injury and disease progression. Thus, individuals living in disadvantaged communities face environmental factors that minimize their health and exacerbate poor outcomes, adding further barriers to care, especially 

Structural barriers in disadvantaged neighborhoods, such as distance to transplant centers, transportation burdens, and lack of local primary care physicians reflect systemic flaws in the catering of the healthcare system towards advantaged communities.

A majority of patients in these communities either lack awareness or the time to receive routine wellness checks related to the often silent disease of CKD. By the time a patient presents with symptoms of kidney deterioration, they’re often passed the point of early stages and require more in-depth treatment, according to experts. The issue of access and resources will not ultimately resolve itself once a patient presents with symptoms that need treatment.

Patients experiencing CKD in the later stages, especially end stage kidney failure (ESKD) will require dialysis, or in severe cases, transplantation. However, the barriers to care that existed in the beginning stages of their illness become even more pronounced once they require help.

“Neighborhood disadvantage puts people out of the running,” said Clark-Cutaia about the entire continuum of kidney care.

According to a recent study, neighborhood disadvantage is linked to a significant lack of access to waitlisting and kidney transplantation, especially living donor kidney transplantation. This reality can be seen as a representation of the double-sided nature of neighborhood disadvantage and kidney health as the root of the problem and a barrier to a solution.

To combat neighborhood disadvantage and its downstream effects, it is important to meet patients where they are. As clinicians, that means creating a presence in communities through churches, mosques, workplaces, farms, or by connecting with community leaders to build trust in the healthcare system.

Awareness and access can play a major role in improving patient outcomes. For example, on-site education and screening to reduce transportation/time burdens, along with mobile units for blood and urine testing can bypass systemic barriers and help patients get the preemptive help they need.

To address social determinants of health, clincians should aim to implement earlier screening and referrals and to connect patients to social workers for food transporation and social support needs.

Ethically and clinically, health care practitioners have a responsibility to their patients to treat neighborhood disadvantage as a clinical value and to find solutions for these barriers to care the same way they would treat an erroneous lab measure.

 is the inaugural Evelyn Lauder Associate Dean for Nurse Practitioner Programs and Professor at the Hunter-Bellevue School of Nursing at Hunter College.

 is a NIHR Advanced Fellow and Associate Professor (Principal Research Fellow) in Nutrition and Dietetics in the Centre of Obesity Research at University College London (UCL) and programme co-lead of the MSc Dietetics (Pre-registration) course at UCL.

 is the Chief Medical Officer at Evergreen Nephrology.

 is the Chief Executive Officer and Founder of Carna Health.

 is a nephrologist and Professor of Public Health Sciences and Medicine, Division of Nephrology and Hypertension at Loyola University Chicago, and the Editor in Chief of 

 is a postdoctoral researcher at the Leverhulme Centre for Demographic Science at the University of Oxford.

 is the Dr. Robert H and Eva M Moyad Research Professor of Urology, Co-Chief of Dow Division of Health Services Research, Professor of Internal Medicine, and Professor of Urology at the Medical School at the University of Michigan.

Editor’s Note: Cutaia declares no relevant disclosures. Brown reports no relevant disclosures. Pflederer reports relevant disclosures with Evergreen Nephrology. Viscomi reports relevant disclosures with Carna Health, Dama Health, QuantaBrain, and others. Shahinian reports no relevant disclosures.

Neighborhood Atlas - Home. Wisc.edu. Published 2018. 

https://www.neighborhoodatlas.medicine.wisc.edu/

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Rhone A. USDA ERS - Documentation. Usda.gov. Published January 5, 2025. 

https://www.ers.usda.gov/data-products/food-access-research-atlas/documentation

American Kidney Fund. Kidney-friendly eating plan | American kidney fund. www.kidneyfund.org. Published December 1, 2021. 

https://www.kidneyfund.org/living-kidney-disease/healthy-eating-activity/kidney-friendly-eating-plan

Bellasi A, Di Lullo L, Di Iorio B. Chronic Kidney Disease: The Silent Epidemy. 

7 experts come together to address neighborhood disadvantage and its impact on kidney health in the latest Crisis Point. 

Maya Clark Cutaia, PhD, RN

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