Structural Racism and Chronic Kidney Disease Among African Americans: A Research Process Guided by Public Health Critical Race Praxis.

Structural racism has a profound impact on the ability of Black patients to access needed chronic kidney disease (CKD) treatment and care. Studies that have documented various forms of inequities in CKD diagnosis and treatment of CKD among Black patients are mostly focused on kidney disease outcomes with little attention to the processes of intervention implementation. Focusing on outcomes alone tends to assume the process of research, including study design and implementation, is neutral to the outcome. In actuality, the process, including methods employed by the researcher, all influence and shape the outcomes of research. Thus, closing gaps in differences in health outcomes requires a different approach; one that attends to the critical role of 'the process' of investigating these outcomes in research. In this paper, we focus on the processes employed to develop an intervention to address the role of structural racism in CKD treatment and care while acknowledging the importance of documenting disparities in outcomes. We emphasize the need to prioritize engagement with community leaders in the process of research interventions to be implemented in the community.