Race-Based Kidney Test Perpetuated Health Disparities, Sparks Change
A controversial medical algorithm that used race to assess kidney function has been at the center of a heated debate in the nephrology community. For years, the equation to estimate glomerular filtration rate (eGFR) included a racial adjustment that made Black patients’ kidneys appear healthier than they actually were. This practice led to delayed diagnoses, undertreatment, and reduced access to transplants for many Black Americans.
The fight to remove race from the equation was led by young physicians and medical students who recognized the harm caused by this race-based approach. They faced significant pushback from established nephrologists who had long used and defended the algorithm. The battle highlighted generational divides and exposed deep-seated issues of power and resistance to change within the medical establishment.
James Cannon, a 73-year-old retired Minnesota state judge, experienced the consequences of this race-adjusted equation firsthand. His lab results showed different numbers for “African American” and “if not African American,” leading to delayed treatment and a longer wait for a kidney transplant.
The controversy reached a tipping point in 2020, amid the COVID-19 pandemic and racial justice protests. After contentious debates and a task force review, the National Kidney Foundation and American Society of Nephrology recommended removing race from the equation in September 2021.
This change has had significant impacts. The Organ Procurement and Transplant Network has since adjusted waiting times for Black patients whose care was delayed due to the race-based equation. Over 16,000 Black patients have received waiting-time modifications, with nearly 4,000 receiving new kidneys.
While progress has been made, the fight to remove race from the kidney function equation revealed deeper issues in medicine. It highlighted the need for diverse voices in medical decision-making and the importance of questioning long-standing practices that may perpetuate health disparities.
See “Inside the bruising battle to purge race from a kidney disease calculator” (September 5, 2024)
