Minneapolis-based M Health Fairview will stop automatically adjusting for race in a formula commonly used to measure kidney function, the health system said March 16.
The estimated glomerular filtration rate, or eGFR, was developed more than 20 years ago to help clinicians evaluate kidney health. The equation uses creatinine — a waste product produced by the muscles and filtered out by the kidneys — and a number of other factors to estimate a person's kidney function. At the time it was developed, researchers were trying to understand everything that makes a difference in kidney function and included age, sex and race in the caclulation.
"And they didn't necessarily think about 'Why does race make a difference?'" said Kristina Krohn, MD, hospitalist at M Health Fairview and chair of the task force that decided to end the practice of using race as a component in the eGFR equation. "The assumption was that it was muscle net difference, but the studies of muscle mass difference were actually not very good and pretty racist. As we get to the point where we're evaluating our use of race, we can't say why it's in the equation in the first place. That gets to be problematic," Dr. Krohn told Becker's.
The formula is based on the incorrect assumption that race is biological and can overestimate Black patients' kidney health.
"So, it can be later in the disease course that someone gets recommended to see a nephrologist," Dr. Krohn said. "It can be later in the disease course that someone is listed for a transplant. We know that African Americans have a faster progression of kidney disease, but this also prevents us from picking it up early. Rather than helping us to decrease racial disparities, it seems to perpetuate them."
Effective in July, M Health Fairview will no longer use race in the eGFR equation. In recent years, a number of other hospitals, including Boston-based Beth Israel Deaconess Medical Center, have moved to eliminate the use of race in the formula.
Hospitals and health systems have taken it upon themselves to reconsider the use of race as a kidney health determinant while they await a national recommendation from the National Kidney Foundation and the American Society of Nephrology.
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