Podcast Summary
EGFR may disadvantage Black patients due to automatic race coefficient: The eGFR diagnostic tool, used to assess kidney health, may unfairly impact Black patients by increasing their estimated values, potentially limiting their access to transplants and specific care.
The widely used diagnostic tool for assessing kidney health, eGFR (estimated glomerular filtration rate), may disadvantage Black patients due to an automatic race coefficient that increases their estimates. This practice, which has been a topic of debate for years, is driven by recent concerns raised by medical students like Naomi Nkenzi. The consequence of this difference in estimates can impact patients' access to kidney transplants and certain types of care. A recent study in the Boston area revealed that without the race coefficient, 64 additional patients would have qualified for further evaluation. This raises questions about the fairness and accuracy of this diagnostic tool, emphasizing the need for continued dialogue and potential adjustments to ensure equitable healthcare for all.
The use of race in estimating kidney function: Medical students question the physiological reasoning and implications of race-based eGFR adjustments, leading to their discontinuation at one health system, but the debate continues in kidney medicine.
The use of race in estimating kidney function through the eGFR equation has been a topic of controversy and debate in the medical community. The discussion revolves around the biological justification for adjusting kidney function based on race, and the potential implications for patients, particularly those of African descent. During a lecture, a medical student, Naomi, raised concerns about the physiological reasoning behind the race adjustment and its impact on patients. She questioned the pathway for melanin leading to different kidney function, the determination of "Black enough" for the measurement, and the handling of mixed-race individuals. The professor did not have satisfactory answers to these questions. Naomi and her peers continued to advocate for change, engaging with other students, faculty members, and the head of nephrology. Their efforts led to the University of Washington Health System announcing the discontinuation of using the race-based eGFR equation in their labs. However, the debate about the value of race adjustment in eGFR is ongoing, and not all in kidney medicine agree on dropping it immediately. This discussion highlights the complexities and ongoing debates surrounding the use of race in medical diagnoses and treatments, and the importance of questioning and challenging these practices.
The use of race in estimating kidney health through eGFR: The practice of using race in estimating kidney health through eGFR, based on a small study from 1999, raises concerns about potential inaccuracies and biases.
The estimation of kidney health through eGFR involves the use of creatinine levels as a proxy. However, the incorporation of race into this estimation is problematic. This practice was initiated based on a study from 1999 with a small sample size of only around 200 black participants out of a total of 1600. Researchers found that black participants had higher creatinine levels than white participants with the same actual GFR. In response, they introduced a race multiplier to the equation. Critics argue that this normalizes black patients to white patients, making assumptions about an entire population based on a small study. It's important to note that the race multiplier is not based on any inherent biological difference but rather on historical data. This raises concerns about potential inaccuracies and biases in the estimation of kidney health.
Racial differences in muscle mass and kidney function assessments: The use of race-adjusted GFR in kidney function assessments remains a debated topic. While some argue that racial differences in muscle mass justify adjustment, critics claim that this idea is not based on solid evidence and that socioeconomic factors, diet, and medications may be more significant contributors to observed differences.
The use of race-adjusted GFR (Glomerular Filtration Rate) in kidney function assessments is a topic of ongoing debate. A recent study suggested that racial differences in muscle mass could explain the need for race adjustment in these equations. However, critics argue that this idea is not rooted in solid scientific evidence and is outdated, as older studies used to support this theory are small and outdated. Furthermore, socioeconomic factors, diet, and medications may be more significant contributors to the observed differences between black and white patients. Transparency with patients regarding the use of these equations and the reasons behind any observed differences is crucial. Since the 1999 study, there have been revisions to the equation to include more diverse populations, but the need for race adjustment remains a contentious issue.
Using race multipliers for kidney function estimates highlights limitations: While race multiifiers improve accuracy for some populations, they also underscore eGFR's imprecision and the complexities of racial differences in healthcare.
While the use of race multipliers in estimating kidney function (eGFR) can make the estimates more accurate for certain populations, such as Black patients, it also highlights the limitations and imprecision of eGFR as a tool. Critics argue that race is a social construct and that there is significant diversity within racial groups, making it challenging to use race as a monolithic factor in medical assessments. However, ignoring observed racial differences in eGFR estimates could lead to misdiagnosis or exclusion from certain treatments for Black patients. Moreover, eliminating the use of race multipliers won't magically erase existing health disparities. Instead, it's essential to consider the data thoughtfully and acknowledge the complexities and nuances of racial and ethnic differences in healthcare.
Debate on Dropping Race-Adjusted GFR in Kidney Function Assessment: The debate on dropping race-adjusted GFR in kidney function assessment is ongoing, with arguments for potential equity and disparity elimination, and concerns over unintended consequences such as fewer transplants and medication access for black people. The outcome is uncertain, with new recommendations being developed.
The debate around dropping race-adjusted GFR (Glomerular Filtration Rate) in kidney function assessment is complex and multifaceted. While some argue that it could lead to more equitable healthcare and eliminate potential disparities, others warn about potential unintended consequences such as fewer black people being eligible for kidney transplants and differences in medication access. The National Kidney Foundation and American Society of Nephrology are currently working on new recommendations, but the outcome is uncertain. Ultimately, all interviewees agreed that an ideal world would be one where race is not a factor in healthcare, but the best solution for achieving this is still up for debate. Additionally, there is a possibility that more accurate methods of measuring GFR or alternative ways of estimating kidney function could eliminate the need for race adjustment altogether.
Doctors reconsider eGFR as sole kidney function assessor: Doctors are exploring alternatives to eGFR for assessing kidney function, including eGFR ranges and other biomarkers. The use of eGFR for patient care decisions is being reconsidered, but specific changes are uncertain.
Doctors are reconsidering the use of estimated Glomerular Filtration Rate (eGFR) as the sole tool for assessing kidney function in patients. Several doctors in a recent discussion suggested alternatives like using an eGFR range or looking at other biomarkers. The exact changes to the use of eGFR are uncertain, ranging from eliminating the race-adjusted GFR altogether to tweaking the equation or keeping it with some caveats. Regardless, there is a consensus that eGFR should not be the sole determinant of patient care decisions. The episode was produced by Rebecca Ramirez, edited by Vietley, and fact-checked by Arielle Zabidi. Listen to The Bid from BlackRock for insights on investment challenges and solutions.
