Christina Pierre, PhD, DABCC, FAACC, clinical chemist, director, Clinical Chemistry Section.
For more than two decades, common calculations used to estimate kidney function, or the estimated glomerular filtration rate (eGFR), have included race – Black and non-Black – as a variable.
In fall 2021, a task force established by the National Kidney Foundation and the American Society of Nephrology, backed by research from the Perelman School of Medicine at the University of Pennsylvania, recommended that race no longer be used in eGFR test results – ultimately promoting health equity and increasing Black patients’ access to kidney transplants.
Penn Medicine Lancaster General Health stopped using race when reporting eGFR findings on November 29, 2021.
The clinical change was identified as a key priority for Penn Medicine’s Action for Cultural Transformation (ACT) strategic plan that launched in 2020. Through the ACT, the health system’s goal is to bring together as many diverse voices as possible to identify key goals and provide fresh insight on actions that will strengthen our organization.
Understanding the Need for Change
“Black patients are at higher risk for developing kidney failure that requires dialysis or kidney transplant and have a higher prevalence of diabetes and hypertension, which are major drivers of disproportionate chronic kidney disease burdens,” said Christina Pierre, PhD, a clinical chemist and section director of clinical chemistry testing, who spearheaded the implementation of the new eGFR equations at Penn Medicine Lancaster General Health.
The common eGFR equations estimate kidney function based on measured creatinine levels while also considering a patient’s age, gender and race.
With the former measurement practice, eGFR equation assigned a higher estimated kidney function to Black patients compared to non-Black patients at the same serum creatinine concentration. This meant that a Black patient needed to reach a higher creatinine level than non-Black patients to be referred for a nephrology consult, or to be put on the kidney transplant waitlist.
“Algorithms, risk scores and calculations that incorporate race, such as the two most commonly used eGFR equations, are utilized in multiple areas of medicine. The practice of using race to infer and/or assign physiologic attributes is flawed for several reasons,” Pierre added.
“Race correlates with ancestry, but imperfectly so. Physical attributes such as skin color should not be used as a surrogate for genetics.”
Eliminating the use of the racial multiplier in eGFR testing and introducing alternative testing methods are helping to substantially reduce racial bias in kidney treatment.
“This change is a small but historic step in providing more equitable care for our patients,” said Pierre.