More than 37 million adults have kidney diseases, kidney failure, or kidney transplants in the United States, with disproportionate prevalence among minority populations. NKF and ASN are committed to, and highly engaged in, promoting health equity as well as addressing and eliminating racism and ethnic disparities in kidney health and medicine. Systemic racism is unacceptable in any arena, including health care, and both organizations are confronting it directly because we believe doing so will improve the health, safety, and equity of our patients. When announcing the establishment of the task force, NKF and ASN affirmed that race is a social, not a biological, construct and that including adjustment for race in the calculation of eGFR ignores the substantial diversity within self-identified Black or African-American patients and other racial or ethnic minority groups.
Since September 2020, the NKF-ASN Task Force has been examining every aspect of the inclusion of race in calculations that estimate adult kidney function and are used in both diagnosis and treatment. Specially, NKF and ASN charged the task force to:
- Recognize that any change in eGFR reporting must consider the multiple social and clinical implications, be based on rigorous science, and be part of a national conversation about uniform reporting of eGFR across health care systems.
- Incorporate the concerns of patients and the public, especially in marginalized and disadvantaged communities, while rigorously assessing the underlying scientific and ethical issues embedded in current practice.
- Ensure that GFR estimation equations provide an unbiased assessment of kidney function so that patients, clinicians, laboratories, and public health officials can make informed decisions to ensure equity and personalized care for patients with kidney diseases.
- Keep patients, clinicians, laboratories, and other public health officials apprised of any potential long-term implications of removing race from the eGFR formula.
The NKF-ASN Task Force is hearing from experts on a variety of topics related to this charge, including individuals with knowledge and expertise in race, racism, genetic ancestry, kidney filtration markers, glomerular filtration measurement, laboratory measurement and standardization, clinical practice guidelines, shared decision making between physicians and patients, and perspectives from patients.
After hearing from these experts and reviewing published scholarly work to inform its forthcoming preliminary report, the NKF-ASN Task Force would now like to hear from the kidney community and other stakeholders on the breadth of topics reviewed, the implications in the estimation of kidney function, and alternative approaches to the current calculations used for kidney function estimation. NKF and ASN invite all those interested to participate in this process as the task force seeks a solution to address its charge that is safe; equitable; will not disadvantage any patient by race, sex, or age; and will promote accurate and consistent GFR estimation for all patients throughout the United States.