Race-neutral kidney disease screening formula facing criticism Image By HPN Staff Key Points In 2021, the NKF-ASN recommended replacing the prior CKD-EPI kidney function formula (which included a race adjustment) with a race-neutral version to reduce racial bias in CKD diagnosis. Critics argue the new formula may underestimate kidney function in Black patients and overestimate it in non-Black patients, potentially shifting diagnoses, referrals, and transplant eligibility in unintended ways. Studies cited suggest the change could disqualify some otherwise eligible Black kidney donors, while the U.S. continues performing record numbers of kidney transplants each year. A recently adopted race-neutral formula used to evaluate the risk of chronic kidney disease (CKD) may instead be leading to inaccurate diagnoses and disqualifying otherwise valid potential kidney donors. Proponents of the new formula say it is designed to eliminate racial bias from medical decisions, but studies show that it could also be leading to fewer donors being qualified for these transplants. Before 2001, a Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula was used to measure serum creatinine concentrations in patients to determine the estimated glomerular filtration rate (eGFR). That measurement is a clinical marker to determine the presence and severity of chronic kidney disease, including a race coefficient to account for higher natural levels of serum creatinine typically found in Black patients. In 2021, in the wake of the racial unrest that swept the country following the death of George Floyd, the National Kidney Foundation – American Society of Nephrology (NKF-ASN) Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease recommended the adoption of a new formula to determine eGFR that did not include race. Why it matters Many in the medical community assert that the inclusion of race in the algorithms may have resulted in inaccurate diagnoses, negatively impacting Black patients by limiting their access to kidney transplants. They argue that race is a social, not a biological construct. Other experts, however, are questioning the wisdom of the now widespread adoption of the new formula. Stanley Goldfarb, a nephrologist and chairman of Do No Harm, an organization of medical professionals who oppose the imposition of “identity politics” in medicine, wrote recently in City Journal that “The new formula… underestimates kidney function in Black patients and overestimates it for white patients.” He added that “Removing the race adjustment will lead to Black patients receiving sooner-than-necessary referrals for kidney care and transplants, while slowing white patients’ access to the same procedures.” Dr. Goldfarb cites studies, including a 2022 article published in the Journal of the American Society of Nephrology, which determined that nationwide implementation of the new race-neutral formula could result in 434,000 new diagnoses of CKD and 584,000 reclassifications to more advanced stages of CKD for Black adults. At the same time, it would remove CKD diagnosis from 5.51 million non-Black adults and reclassify 4.59 million non-Black patients to less advanced stages of CKD. Another study published in the American Journal of Surgery concluded that the use of the new formula could lead to incorrect diagnoses of CKD in potential kidney donors who are Black, removing them from the donor pool. The bigger picture The U.S. continues to perform record numbers of kidney transplants each year. Reports show more than 25,000 transplants were performed in 2022, with more than 28,000 taking place in 2023. SUGGESTED STORIES Heart attacks no longer the leading cause of heart disease deaths Heart disease remains the leading cause of death in the U.S., but the types of heart conditions causing those deaths are changing. While deaths from heart attacks have dropped significantly over the past five decades, fatalities from other forms of heart disease — especially heart Read more Biden's diagnosis points to imperfect screening Former President Joe Biden’s recent prostate cancer diagnosis — and the revelation that his last known screening was more than a decade ago — highlights the double-edged sword of prostate testing. Prostate cancer is the second most common cancer in men, after skin cancer. And it’s t Read more NIH rewrites the pandemic playbook National Institutes of Health (NIH) Jay Bhattacharya and NIH Principal Deputy Director Matthew J. Memoli set off a firestorm in November by declaring it time to “stop wasting money on the traditional [pandemic] playbook.” Bhattacharya and Memoli argued in The Read more
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