Important changes are taking place in the ways American medical professionals diagnose and treat kidney disease for Black patients. The Kidney Foundation of Western New York is working to share updated information with people at risk of kidney problems, as well as local health care providers.
Diabetes and high blood pressure are the leading risk factors for kidney disease. Heart disease, obesity, lupus, a family history of kidney disease, and high cholesterol all increase the likelihood that a person will develop kidney disease. Black patients are disproportionately affected by kidney failure. The National Institute of Diabetes and Digestive and Kidney Diseases reports that 35 percent of the people with kidney failure in the United States are Black, while making up 13 percent of the U.S. population.
Estimated glomerular filtration rate (eGFR) is one of the main methods for detecting and managing kidney disease. A person’s age and sex are among the factors used in calculations for making the estimation. Until recently, many medical laboratories in the United States calculated eGFR using different adjustments for Black and non-Black patients. This was based on an assumption that Black people have a higher average muscle mass. In the past few years, concerned patients and medical professionals have called for the calculation to be reexamined.
A New Method
“Inclusion of race in GFR estimating equations, along with other algorithms in medicine, is facing increasing scrutiny because race is a social and not a biologic construct; its inclusion ignores diversity within and among racial groups and may contribute to systemic racism in medicine,” members of the Chronic Kidney Disease Epidemiology Collaboration wrote in 2021.
Researchers found that diagnoses of chronic kidney disease among Black adults would increase if race adjustments were eliminated. Accurate eGFR is important because the number is used in diagnosing kidney disease, selecting dosage for medications, and evaluating the need for kidney dialysis or transplant. Primary care doctors also use eGFR in deciding when to refer a patient to a nephrologist, a doctor specializing in kidney care.
The American Society of Nephrology and partners released a new race-free calculation for estimating GFR in September 2021. A task force approved the new calculation after examining many ways of approaching the problem and seeking input from patients and health professionals. Since the new eGFR method was approved, laboratories and hospitals across the country have begun to implement it, including systems serving the Buffalo area.
The Kidney Foundation of Western New York is working to provide information on the new eGFR calculation to local medical professionals. The foundation also encourages people with a diagnosis of kidney disease, or those with key risk factors, to recognize that their options for treatment may have changed.
Underdiagnosis and Undertreatment
The task force examining eGFR found that Black patients had worse outcomes for blood pressure control, nephrology referral, preparation for starting dialysis and receiving a transplant compared to white patients. The task force also noted that Black patients were less likely to receive medication for controlling diabetes and adequate doses of pain and cancer medication.
Researchers found that eliminating race adjustments in eGFR will likely lead to sizable changes in the prescription of medication for Black adults. “The new approach may report a different eGFR and could alter the stage of kidney diseases in some people,” the American Society of Nephrology stated when announcing the new standards. “It’s important for patients to speak with their doctors to determine if this may affect their treatment and care going forward.”
Adjusting the Transplant Waitlist
Since there are fewer kidneys available than there are people in need, individuals hoping for a transplant are placed on a national waitlist. When a kidney becomes available from a deceased donor, a patient’s ranking on the waitlist is calculated based on several factors including blood-type matching, antibody matching, and how long a person has had kidney failure.
Beginning in January 2023, the Organ Procurement and Transplantation Network (OPTN) adopted a policy meant to backdate the waiting times of Black kidney transplant candidates who have been disadvantaged by the use of past race-inclusive calculations to estimate their level of kidney function. During this year, all kidney transplant programs must identify Black kidney candidates whose qualifying date was based on the use of a race-inclusive eGFR calculation and determine whether a race-neutral eGFR calculation shows they should have qualified sooner to start gaining waiting time for a transplant. Programs must then apply to the OPTN for a waiting time modification for such candidates. Hospital transplant programs must contact each candidate to let them know if they qualify for a waiting time adjustment.
People with kidney disease, family members and medical professionals can contact the Kidney Foundation of Western New York for tools and resources related to the new eGFR method. Information is online at www.kfwny.org/egfr or by calling 716-529-4390.
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The Kidney Foundation of Western New York works to increase awareness of kidney disease, provide education on kidney health, and support patients and their families. The locally based non-profit serves Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming counties.
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