Renal disease in African Americans is the most dramatically different prevalence of a disorder and results in significant disability, morbidity, and mortality. As end-stage renal disease is principally a result of diabetes and hypertension, and given the increased prevalence of both in African Americans, there is at least a threefold increased occurrence of renal disease in African Americans. The excess burden of kidney disease (both diabetic and nondiabetic) has been largely explained by genetic variants in the apolipoprotein 1 gene (APOL1) in African Americans. African Americans make up 35% of all patients on chronic dialysis, with diabetes as the leading cause of renal failure, and hypertension as the second most prevalent cause. This chapter will review these and other important differences.