Implications of Race-Based Estimates of Kidney Function

• Activity Number: 133 - Equity in Innovation: Should Race and Ethnicity Be Included in Clinical Prediction Models and Algorithms?
• Type: Topic Contributed
• Date/Time: Monday, August 8, 2022 : 10:30 AM to 12:20 PM
• Sponsor: Biometrics Section
• Author(s): Leila Zelnick*
• Companies: University of Washington
• Keywords: equity; race-based medicine; kidney disease; prediction

Abstract

Direct measurement of the glomerular filtration rate (GFR), the primary clinical measure of kidney function, requires burdensome procedures and rarely occurs outside of research settings. Thus, GFR estimating equations are ubiquitous in clinical medicine. Most equations estimating GFR are based on blood levels of creatinine, a waste product produced by muscle; the most popular equations include a “race coefficient” that assigns 16%-21% higher values to Black patients, based on observations that people self-identifying as Black can have higher average levels of creatinine in their blood. However, growing awareness of race as a social construct, potential harms of race-based medicine, and equity concerns have led researchers and clinicians to reconsider the use of race-based estimates of kidney function. This talk will review evidence motivating race-based kidney function estimates and subsequent contradictory evidence. We will discuss impacts of race-based estimates of kidney function on clinical outcomes, especially kidney transplant eligibility and other actionable hard clinical thresholds, and summarize recent developments in the debate in academic circles and the popular press.