A Step Toward Health Equity for Veterans: Evidence Supports Removing Race From Kidney Function Calculations

Area of Science:

• Nephrology
• Medical Ethics
• Health Equity

Background:

• Race is a sociopolitical construct, not a biological determinant of genetic ancestry.
• Clinical algorithms using race modifiers, like Black race coefficients in eGFR, lack biological basis and worsen health inequities.
• The historical use of race in medical equations is increasingly scrutinized for scientific inaccuracy and ethical concerns.

Purpose of the Study:

• To review the history, evidence, and implications of using a Black race coefficient in estimated glomerular filtration rate (eGFR) calculations.
• To examine the impact of race-based adjustments on kidney disease diagnosis and management.
• To advocate for equitable and accurate kidney function estimation.

Main Methods:

• Analysis of the Modification of Diet in Renal Disease (MDRD) equation used by the US Department of Veterans Affairs.
• Review of studies comparing race-based vs. race-neutral eGFR estimation across diverse populations.
• Examination of the biological plausibility and precision of current eGFR algorithms.

Main Results:

• The MDRD equation includes a Black race coefficient, inflating eGFR by 21% for Black patients compared to others.
• Studies show race-based eGFR calculations are inferior to race-neutral options in diverse Black populations.
• Current widely used eGFR equations are biased and imprecise, impacting patient care.

Conclusions:

• Incorporating race coefficients into kidney function estimation lacks biological validity and exacerbates health disparities.
• A race-neutral option for eGFR calculation should be implemented for all patients.
• Accurate and equitable kidney function estimation is crucial for timely diagnosis, management, and treatment planning for kidney disease.