Michel Brathwaite, M.D.

Black Americans make up 13 percent of the U.S. population but nearly 35 percent of patients on dialysis (USRDS, 2023). Black adults are 3 to 4 times more likely to develop end-stage kidney disease and reach kidney failure up to a decade earlier than white adults, largely driven by APOL1 gene variants, hypertension, and diabetes. Nephrologists manage chronic kidney disease long before dialysis, slowing progression, adjusting medications, and preparing for kidney transplant or home dialysis if needed.

Early nephrology referral (eGFR < 30 but not on dialysis) reduces mortality by an estimated 20-30 percent (JASN, 2018).

Conditions we cover

• Chronic kidney disease (stages 3-5)
• Diabetic and hypertensive nephropathy
• Glomerular disease (FSGS, lupus nephritis)
• Kidney transplant evaluation and follow-up
• Polycystic kidney disease

When to book

• eGFR below 60 on two labs
• Protein or blood in urine
• Uncontrolled blood pressure despite 3+ medications
• Family history of kidney failure

Advocacy prompts

• Should I be tested for APOL1 variants given my family history?
• Can you refer me for transplant evaluation now, before I need dialysis?
• Which of my medications might be harming my kidneys?