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Neighborhood Disadvantage As a Clinical Variable For Kidney Care, With Maya Clark Cutaia, PhD, RN
Should clinicians consider neighborhood disadvantage the same way they measure proteinuria and GFR for kidney health?
Considering neighborhood disadvantage as a clinical variable may be a useful strategy for supporting populations with reduced socioeconomic status in their kidney health, especially chronic kidney disease (CKD), according to an expert.
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 HCPLive. “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.”
References
Surachman A. Neighborhood Deprivation, Financial Hardship, and Decrements in Kidney Function Across a Decade. Innovation in Aging. 2025. doi:https://doi.org/10.1093/geroni/igaf122.4413
Li Y, Menon G, Kim B, et al. Residential Neighborhood Disadvantage and Access to Kidney Transplantation. JAMA Network Open. 2025;8(12):e2549679-e2549679. doi:https://doi.org/10.1001/jamanetworkopen.2025.49679
Eisenbeisz ME, Chertow GM. Diminished Access to Dialysis in Disadvantaged Communities—Driving Toward More Equitable Care. JAMA Internal Medicine. Published online February 23, 2026. doi:https://doi.org/10.1001/jamainternmed.2025.8037
