Though racism pervades throughout the current world, it is often viewed as a deeply internal prejudice within certain individuals. Quantitative metrics disadvantaging people of color should have been wiped out by now, right?
Well, not quite.
Anthony Randall, a barber from Los Angeles who is unable to work due to kidney disease and undergoes dialysis three times weekly, has been on the kidney transplant waiting list for over five years. In April of 2023, he sought federal court approval to represent a class of 27,500 Black U.S. patients who he claims have faced similar disadvantages.
When kidney transplant recipients are considered for transplantation, an estimated glomerular filtration rate (eGFR) is calculated to determine the rate at which creatinine, a waste product, is filtered from the blood. In 1999, the formula for calculating eGFR was altered to produce different results for colored individuals compared to others. This change was based on an outdated theory about creatinine levels, which argued that people of African descent. Until recently, this resulted in lab reports displaying two distinct results: one for non-Black patients and another for Black patients, which could overestimate kidney function by as much as 16%.
Furthermore, an investigation was launched by the American Society of Nephrology and the National Kidney Foundation. The researchers evaluated a new eGFR formula that omits race adjustment. They discovered that using the race-free eGFR formula, kidney failure occurred in 350 Black patients at an average of 23 months, compared to 22 months for 122 white patients, a difference the researchers considered not statistically significant.
Elaine Ku, an MD of the UCSF Division of Nephrology and Department of Epidemiology and Biostatistics, noted the promise of such a race-blind formula: “Our data suggest that using the race-free creatinine equation to determine waitlist eligibility is the strategy that may reduce racial differences in access to pre-emptive wait-time accrual the most, though our findings require additional confirmation in other cohorts.”
Ultimately, the ongoing disparities in the calculation of eGFR highlight the persistence of systemic racism within medical practices. The efforts by organizations like the American Society of Nephrology and the National Kidney Foundation to develop and implement a race-free eGFR formula are steps in the right direction toward equitable healthcare. These initiatives not only promise to improve the accuracy of medical assessments, but they also aim to dismantle the remains of racial prejudice in healthcare systems. Moving forward, the medical community must scrutinize and reform practices to ensure fair treatment for all individuals, reaffirming the principle that access to healthcare and medical treatment should never be influenced by race.
Associated Press. 1 Apr. 2024, apnews.com/article/
kidney-transplant-race-black-inequity-bias-d4fabf2f3a47aab2fe8e18b2a5432135. Accessed 29 Apr.
2024.
University of California San Francisco. 19 Sept. 2022, www.ucsf.edu/news/2022/09/423741/
black-patients-nixing-race-adjustment-may-improve-kidney-transplant-odds. Accessed 29 Apr.
2024.
The Washington Post. 10 Apr. 2023, www.washingtonpost.com/health/2023/04/10/
lawsuit-unos-kidney-transplant-race-discrimination/. Accessed 29 Apr. 2024.