Kidney disease continues to manifest stark U.S. racial inequities, revealing the entrenchment of racism and bias within multiple facets of society including in our institutions, practices, norms, and beliefs. In this perspective, we synthesize theory and evidence to describe why an understanding of race and racism is integral to kidney care, providing examples of how kidney health disparities manifest interpersonal and structural racism. We then describe racialized medicine and color-blind approaches as well as their pitfalls, offering in their place suggestions to embed anti-racism and equity lens into our practice.