Panel: Take race out of kidney diagnoses
A scientific task force Thursday called for jettisoning a common measure of kidney function that adjusts results by race, providing different assessments for Black patients than for others.
The adjustment may make Black patients seem less ill than they really are, according to many experts. Instead, doctors should rely on a race-neutral method for diagnosing and managing kidney disease, a report from the National Kidney Foundation and the American Society of Nephrology said.
The specific equation recommended was described in a study published Thursday in the New England Journal of Medicine.
If adopted, the new approach would affect hundreds of millions of kidney function tests performed yearly in hospitals and outpatient settings, both for acutely ill patients and as part of routine screening blood tests. By one estimate, 1 million Black Americans might be treated earlier for kidney disease if the diagnostic equation were not adjusted for race.
The task force report, published concurrently in the American Journal of Kidney Diseases and the Journal of the American Society of Nephrology, comes amid a national reckoning over racial health disparities spurred by the coronavirus pandemic, which has taken a disproportionate toll on people of color and has highlighted the excessive burdens of chronic disease in those communities.
“The issue is a moral issue,” said Dr. Neil Powe, co-chairman of the task force and chief of medicine at Zuckerberg San Francisco General Hospital and Trauma Center. “It is time to remove race from the equation.”
Black and Hispanic Americans have long suffered from high rates of conditions such as diabetes, high blood pressure and obesity, which can exacerbate a bout of COVID-19. These factors can also increase the risk of developing kidney disease.
The racial disparities in kidney disease are stark and well documented. Black Americans are more than three times as likely as white Americans to experience kidney failure and require dialysis or a kidney transplant.
Although Black Americans make up only 13 percent of the population, they represent 35 percent of Americans with kidney failure. More than 90,000 Americans are on a waiting list for a kidney; nearly one-third are Black, about as many as those who are white.
People of color and low-income Americans are less likely to receive good care when the warning signs first appear and chronic kidney disease could be prevented. They are more likely to progress to kidney failure and to require dialysis and less likely to be cared for by a kidney specialist before getting to that stage, according to a report by the Centers for Medicare & Medicaid Services.