Race should be eliminated from a formula commonly used to evaluate kidney function, according to a Sept. 23 task force recommendation.
The estimated glomerular filtration rate, or eGFR, is an equation developed more than 20 years ago to evaluate kidney health. It factors in race, age, sex and creatine — a waste product produced by the muscles and filtered out by the kidneys. Race was originally included as a factor since studies have shown that Black patients, on average, may have higher levels of creatine in their blood. However, experts have said the studies on which the inclusion of race are based are outdated, and based on the incorrect assumption that race is biological, rather than a social construct.
Thus, many experts warned the formula overestimated Black patients' kidney health, potentially delaying care.
The new recommendation, jointly published in the American Journal of Kidney Diseases and the Journal of the American Society of Nephrology, describes an alternative equation that estimates kidney function without a race variable.
"Using race as a testing factor risks kidney misdiagnosis," said Afshin Parsa, MD, program director of the Chronic Renal Insufficiency Cohort at the National Institute of Diabetes and Digestive and Kidney Diseases. "Misdiagnosis could lead to a person receiving incorrect drug dosing, or delays in receiving dialysis or a kidney transplant. Current eGFR calculations could be exacerbating racial inequities in a disease that disproportionately affects Black people."
The reports also recommend using blood tests that measure cystatin C, a protein that is elevated when kidneys are not functioning well and unlike creatine, is not affected by race or ancestry.
While they waited for the national recommendation, some hospitals and health systems, including Minneapolis-based M Health Fairview and Boston-tased Beth Israel Deaconess Medical Center had already stopped using race as a kidney health determinant.