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Ethical Issues in Dialysis: Institutionalized Racism and End-Stage Renal Disease: Is Its Impact Real or Illusionary?


Address correspondence to: Patrice V. Miles, National MOTTEP/Howard University, 2041 Georgia Avenue, NW, Suite 3100, Washington, DC 20060, or e-mail:


Racism is the subjugation of one group (superior) over another (inferior) and may be divided into two categories: overt (gross) and covert. Covert racism (subconscious) is categorized as institutionalized racism. Although institutionalized racism is a more tolerant and restrained practice of this superior/inferior ethnic construct in which African Americans or other people of color are treated as inferiors, it has led to important health disparities between blacks and whites. One area where its mark is most indelible is in the treatment of end-stage renal disease (ESRD).