Inside the Bruising Battle to Purge Race from a Kidney Disease Calculator

The debate over the use of race in medical assessments has grown increasingly intense in recent years, with one of the most contentious issues being the use of race in eGFR calculators—the tools used to estimate kidney function. Historically, these calculators have factored in race, particularly Black race, to estimate the glomerular filtration rate (GFR), which measures how well the kidneys are filtering waste from the blood. However, a growing movement is calling for the removal of race from these calculations due to concerns about racial disparities in kidney disease diagnosis and treatment.

This blog delves into the ongoing controversy, the efforts to develop eGFR calculators without race, and the broader implications for chronic kidney disease (CKD) care. We’ll explore both sides of the debate and discuss how new guidelines are shaping the future of kidney health assessments.

The Role of eGFR Calculators in Kidney Function Assessment

The estimated glomerular filtration rate (eGFR) is a key metric used by healthcare providers to assess kidney function. It helps diagnose chronic kidney disease (CKD) and determine the severity of kidney damage. Typically, the eGFR is calculated using factors such as age, gender, and serum creatinine levels—an indicator of how well the kidneys are filtering waste. However, traditional eGFR calculators have also included race as a factor, particularly for Black patients​(National Kidney Foundation).

The reasoning behind this race adjustment is based on studies that found higher average muscle mass among Black individuals, which could result in naturally higher creatinine levels. This led to the inclusion of race as a correction factor, which effectively resulted in higher eGFR values for Black patients compared to non-Black patients with the same creatinine levels.

However, critics argue that adjusting for race in kidney disease calculators perpetuates health disparities and can delay CKD diagnosis and treatment for Black patients, who already face higher rates of kidney disease compared to other racial groups​(Stanford FSI).

The Push to Remove Race from Kidney Disease Calculators

As awareness of racial disparities in kidney disease treatment has grown, a push to remove race from eGFR calculators has gained momentum. Opponents of race-based calculations argue that continuing to use race as a factor reinforces outdated concepts of biological differences based on race, which have been debunked. Instead, race is a social construct, and using it in medical diagnostics can lead to misinformed treatment decisions​(UC Davis Health).

In particular, using race in kidney disease calculators can result in Black patients being diagnosed with CKD later than non-Black patients, potentially delaying life-saving treatments such as dialysis or kidney transplantation. This has contributed to a growing movement among healthcare professionals to develop eGFR calculators without race.

Some healthcare organizations and medical associations have already adopted new eGFR calculation guidelines, which remove race as a variable altogether. This shift is part of a larger trend toward addressing health disparities in kidney disease and promoting equity in healthcare​(National Kidney Foundation)​(UC Davis Health).

The Impact of Race-Based Kidney Disease Calculations on CKD Treatment

The use of race in eGFR calculators has broader implications for CKD treatment and outcomes. By giving Black patients higher eGFR values, race-adjusted calculators can underestimate the severity of kidney disease in these individuals, potentially delaying the start of treatment or making them ineligible for kidney transplants.

For example, a Black patient with a race-adjusted eGFR of 60 might be considered to have normal kidney function, while a non-Black patient with the same creatinine levels would have an eGFR of 55, placing them in a category that could trigger further testing or treatment​(National Kidney Foundation). This discrepancy can contribute to racial disparities in CKD outcomes, as Black patients may not receive the same level of care or intervention as their non-Black counterparts.

The removal of race from these calculations aims to address this issue and ensure that all patients, regardless of race, are assessed equally based on their actual kidney function. Several studies have shown that race-neutral calculators provide a more accurate reflection of kidney health and can lead to earlier diagnosis and better management of CKD​(National Kidney Foundation).

New Guidelines and eGFR Calculators Without Race

In response to the growing concerns about race-based kidney disease calculators, leading healthcare organizations have started to issue new eGFR calculation guidelines that exclude race. In 2021, the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) recommended the removal of race from eGFR calculations in an effort to promote health equity in kidney disease diagnosis and treatment​(Stanford FSI).

These new guidelines have been embraced by many healthcare providers, and some institutions have already implemented race-free eGFR calculators. While the transition to eGFR calculators without race has been widely praised, it has not been without controversy. Some opponents argue that removing race could lead to overdiagnosis of CKD in Black patients or result in unnecessary treatments​(National Kidney Foundation).

However, the prevailing view is that eGFR race adjustment removal is a necessary step toward addressing the kidney disease race controversy and ensuring that all patients receive the care they need. The shift toward race-neutral eGFR calculators is seen as part of a broader movement to eliminate racial disparities in healthcare and promote more equitable treatment for all​(Stanford FSI).

The Road Ahead: Addressing Health Disparities in Kidney Disease

While the removal of race from eGFR calculators represents a significant step forward, it is just one part of a larger effort to address health disparities in kidney disease. Black individuals are more likely to develop CKD than other racial groups, and they are less likely to receive early interventions or be placed on the transplant list. These disparities are rooted in a combination of socioeconomic factors, access to healthcare, and historical inequities in the healthcare system​(Stanford FSI).

The battle to purge race from kidney disease calculators is just one facet of the ongoing work needed to close the gap in CKD care for Black patients. Continued advocacy, research, and policy changes are essential to ensuring that all individuals, regardless of race, have access to accurate diagnoses and effective treatments​(UC Davis Health).

Rethinking Race in Kidney Disease Calculations

The decision to remove race from eGFR calculators marks an important turning point in the fight for health equity in chronic kidney disease diagnosis and treatment. By shifting toward eGFR calculators without race, healthcare professionals hope to provide more accurate assessments and better outcomes for all patients, especially those in marginalized communities.

As the healthcare community continues to address the kidney disease race controversy, it’s crucial that new approaches are adopted to promote more equitable care and reduce racial disparities in CKD outcomes. For more information on the latest developments in kidney disease research and health equity, visit Regent Studies for further resources.

To learn more about the push to remove race from kidney disease calculators, check out this source on health equity​(UC Davis Health)​(National Kidney Foundation).