Under a new race-neutral assessment, thousands of African American persons living with chronic kidney disease could gain access to specialty treatment or transplantation for the first time.
University of Maryland Medicine, comprised of the University of Maryland Medical System (UMMS) and the University of Maryland School of Medicine (UMSOM) has announced that it will end the use of a long-standing clinical standard that factors a patient’s race into the diagnosis of chronic kidney disease (CKD). The change could increase access to specialty care, including eligibility for kidney transplantation for thousands of Black people living with advanced kidney disease.
By late January, the System, including the University of Maryland Medical Center (UMMC), will transition to a new standard of evaluating kidney function, eliminating whether a patient is “African American or non-African American” as a factor. The move follows a review by University of Maryland School of Medicine (UMSOM) clinicians and scientists of recently released recommendations from professional societies.
By one estimate, approximately 720,000 African Americans might be treated earlier for kidney disease if race were removed from the calculations of kidney function. In Maryland, and the Mid-Atlantic region more broadly, thousands of people could be impacted by this transition to race-free eGFR.
Since 1999, nephrologists across the country have used an equation to estimate glomerular filtration rate (eGFR), which reflects how well a person’s kidneys filter waste. This equation relies on levels of creatinine – a byproduct of muscle and protein metabolism – from the blood. In addition to age and gender, the calculation takes into account whether a patient is “African American or non-African American” and assigns a multiplier based in part on a discredited notion that Black people tend to have more muscle mass than people of other races.
This higher value often overestimates the health of Black patients’ kidneys, pushing them above the threshold for diagnosis of advanced kidney disease, and therefore, leading to delayed referral for specialty care, or even disqualification for kidney transplant.
Following a report last year in the New England Journal of Medicine, the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) formed a joint task force to review the use of race in eGFR calculations. In September, the group endorsed a new calculation without the race coefficient. A committee of UM Medicine researchers, kidney specialists, clinical quality leaders and health equity champions then convened to review the new guidance and make a strong recommendation for change.
Nationally, African American adults are three times more likely to suffer from kidney failure — making up roughly a third of U.S. dialysis patients, while comprising only 13% of the population. Delays in diagnosis exacerbate this gap — one reason UMMS experts say that while time is of the essence, getting this transition right is equally important.
