Removing Race from Estimates of Kidney Function
March 9, 2021 - A joint statement from the presidents of the American Society of Nephrology and the National Kidney Foundation
More than 37 million adults in the United States have kidney diseases.
A disproportionate number of those people are Black or African American, Hispanic or Latino, American Indian or Alaska Native, Asian American, and Native Hawaiian or Other Pacific Islander, who also face unacceptable health disparities and inequities in health care delivery.
Estimated glomerular filtration rate (eGFR) is one of the primary diagnostic methods for detecting and managing kidney diseases. The eGFR equation includes age, sex, race and/or body weight to approximate directly measured kidney function. However, race is a social, not a biological, construct.
In an update sent to members of the American Society of Nephrology (ASN) and the National Kidney Foundation (NKF), the groups' leaders asserted that race modifiers should not be included in equations used to estimate kidney function. The leaders also stated that current race-based equations should be replaced by a substitute that is accurate, representative, unbiased, and provides a standardized approach to diagnosing kidney diseases.
For that reason, members of the joint Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Diseases have committed countless hours of research, analysis, and discussion to this challenge. While it was originally anticipated that an interim report would be published earlier this year, the thorough and rigorous process the task force is undertaking has necessitated a delay, and the interim report is expected to publish this spring with the final report and recommendations publishing early this summer.
“I applaud the members of the task force for the tremendous amount of time and effort that they have committed to their charge and await their recommendations for the best approach to replace the existing equations for estimating glomerular filtration rate,” said Paul M. Palevsky, MD, FASN, FNKF, president of National Kidney Foundation. “The use of race in clinical algorithms normalizes and reinforces misconceptions of racial determinants of health and disease. We must move beyond this if we are to address the racism and racial disparities that impede the care of people with kidney disease.”
ASN and NKF commit to following up the reports of the task force with a multi-pronged approach, informing professionals and patients of these new recommendations, and how they may affect practice and treatment. Beyond eGFR, ASN and NKF recognize that racism manifests in many aspects of health care. Both organizations commit to providing resources and expertise to the essential job of dismantling systemic racism in nephrology care.
The complex issues this task force has been analyzing, and many other areas of kidney practice and research, have been improved by patients, students, trainees, and health care professionals who have contributed their insights. ASN and NKF are grateful for their insights and support.
“Improving kidney health requires us to dismantle as well as build,” said Susan E. Quaggin, MD, FASN, President of the American Society of Nephrology. “We must replace current race-based equations with a suitable approach that is precise, inclusive, and standardized in every laboratory in the United States.”
About Kidney Diseases
In the United States, more than 37 million adults are estimated to have kidney diseases – and most aren’t aware of it. 1 in 3 American adults is at risk for CKD. Risk factors for kidney diseases include diabetes, high blood pressure, heart disease, obesity, a family history of kidney failure, and being age 60 or older. Black or African American, Hispanic or Latino, American Indian or Alaska Native, Asian American, and Native Hawaiian or Other Pacific Islander people are at increased risk for developing kidney diseases. African Americans are 3 times more likely than Whites, and Hispanics are nearly 1.5 times more likely than non-Hispanics to develop kidney failure.
About the American Society of Nephrology
ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients. ASN has more than 21,000 members representing 131 countries. For more information, please visit www.asn-online.org or contact the society at 202-640-4660.
About the National Kidney Foundation
The National Kidney Foundation (NKF) is the largest, most comprehensive, and longstanding patient-centric organization dedicated to the awareness, prevention, and treatment of kidney diseases in the U.S. For more information about NKF, visit www.kidney.org.