This Practice Point commentary discusses the findings of Lucas et al.'s longitudinal cohort study of chronic kidney disease (CKD) in African American and white individuals with HIV. The study found that--compared with whites--African Americans had a slightly increased risk of incident CKD, but markedly increased rates of estimated glomerular filtration rate decline and progression to end-stage renal disease. This commentary details the clinical implications and limitations of these findings in the context of known racial differences in CKD prevalence and progression to end-stage renal disease in the general population and highlights the importance of screening high-risk HIV patients for kidney disease. CKD is common among HIV patients, and-as in the general population-has a more-aggressive course among African Americans than whites.