A new formula may help black patients’ access to kidney care - Ars Technica

For decades, doctors and hospitals saw kidney patients differently based on their race.

A standard equation for estimating kidney function applied a correction for Black patients that made their health appear rosier, inhibiting access to transplants and other treatments.

In a statement, Paul Palevsky, the foundation’s president, urged “all laboratories and health care systems nationwide to adopt this new approach as rapidly as possible.” That call is significant because recommendations and guidelines from professional medical societies play a powerful role in shaping how specialists care for patients.

A study published in 2020 that reviewed records for 57,000 people in Massachusetts found that one-third of Black patients would have had their disease classified as more severe if they had been assessed using the same version of the formula as white patients.

The traditional kidney calculation was an example of a class of medical algorithms and calculators that have recently come under fire for conditioning patient care based on race, which is a social category not biological one.

The prior formula for assessing kidney disease, known as CKD-EPI, was introduced in 2009, updating a 1999 formula that used race in a similar way.

A person with both Black and white heritage, for example, could flip a health system’s classification of their illness depending on how their doctor saw them or how they identified.

Nwamaka Eneanya, an assistant professor at University of Pennsylvania and a member of the task force behind Thursday’s recommendation, says she knows of one biracial patient with severe kidney disease who after learning about how the equation worked requested that she be classified as white to increase her chances of being listed for advanced care.

Eneanya was a coauthor of the 2020 study on the potential impact of using race in the kidney function equation.

It found 64 cases where recalculating a Black person’s score using the same method as for white patients would have qualified them for a kidney transplant waiting list.

The group also reported that using an additional method of estimating kidney function, based on a less widely used blood test for the compound cystatin C, can be even more accurate across different demographics.

Another paper published in The New England Journal on Thursday by researchers from institutions including UC San Francisco, Kaiser Permanente, and Stanford concluded that using creatinine levels to estimate kidney function without race risked introducing errors, and that adopting cystatin C-based equations was preferable.

In some ways, updating the equation a health care provider uses in nephrology is relatively simple—it requires only a small change to a health system’s electronic records system.