This year, the Hopkins Health System will adopt a race-free kidney function equation in the hopes of allowing more Black patients to have early access to the diagnosis and treatment of kidney diseases. The change will be immediately implemented in hospitals and laboratories affiliated with Hopkins.
Despite Black and non-Black people having similar kidney functions, studies have found that, on average, Black people in the U.S. can have a higher levels of creatinine. The creatinine-based estimated glomerular filtration rate (eGFR), introduced in the 1990s, added a correction factor in calculating the eGFR for Black patients. This correction factor increases the eGFR for Black patients, making it appear that a Black person with the same kidney function as someone of a different race has “healthier” kidneys.
The National Kidney Foundation (NKF) and American Society of Nephrology (ASN) initiated a task force in 2020 to reassess the inclusion of race in eGFR calculation and its impact in patients with kidney diseases. However, it was not until 2021 that NKF released a final report recommending laboratories in the U.S. adopt a new equation that removes the race correction factor.
The removal of this factor has been controversial. Some supporters of the previous algorithm believe that the removal of the correction factor will lead to an over-diagnosis — and over-billing — of Black patients with kidney problems. Opponents claim that race is a social construct and not a reflection of biological differences.
The News-Letter interviewed two physicians from the School of Medicine in regards to their opinions on the new equation.
Dr. Sherita Golden, Hugh P. McCormick family professor of endocrinology and metabolism and vice president and chief diversity officer for the School of Medicine, explained the motivation and timeline behind this change.
“There was a national movement about taking race out of the estimated GFR calculator. That initiative has been going on for a number of years, but probably gained momentum about a couple of years ago,” she said. “The motivation is driven by evidence. [It shows] that including race is not helpful but potentially harmful.”
Dr. Deidra Crews, a professor of medicine in the Division of Nephrology at the School of Medicine, shared her opinion.
“I agree this change will lead to a greater number of Black people in the U.S. [being diagnosed with] kidney disease. What I disagree is on the overburden of bills,” she said. “I have heard countless stories of [Black patients] actually being diagnosed late with kidney disease. There are profound disparities in the progression of kidney disease. Our concern about the timing of the diagnosis outweighs the number of people who get diagnosed.”
Golden also shared her opinion on why race should not be included in the equation.
“Race is a social construct and not a biological construct,” Golden said. “In the way that kidney disease has been assessed previously, African Americans still have a very high burden of chronic kidney disease and renal disease. What we really want to do is to intervene earlier so we can delay the progression of kidney disease, which in the end might decrease the medical burdens.”
Other institutions, such as Beth Israel Deaconess Medical Center in Boston, dropped the race correction factor before Hopkins. Crews explained why it took longer for the University.
“Systemwide changes are not easy to make. We have multiple hospitals and laboratories that are affiliated with Hopkins,” she said. “We would like to wait for the recommendation from the task force and then make a system change.”
According to Golden, this change has brought attention to more racial disparities faced by minorities in health care. She shared her opinion on the impact of the new equation.
“[This change] really made us think about what race represents and what its role is,” she said. “[Race] is more of a social factor that influences health, not a biological factor. When it comes to biology, there is more similarity than difference.”
