US Kidney-Group Presidents Say 'Drop the eGFR Race Modifier'

Mitchel L. Zoler, PhD

March 11, 2021

The leaders of two major US nephrology groups have issued their most forceful call to date for ending use of the race coefficient modifier when calculating estimated glomerular filtration rate (eGFR) for US residents who self-identify as Black.

The two organization presidents also updated the time frame for the release of a highly anticipated report and recommendations on what alternative approach works best for calculating eGFR while minimizing potential biases and disparities.

The report originally was on track for publication by the end of 2020, but the release is now planned for later in 2021.

A race modifier "should not be included in equations to estimate kidney function. Current race-based equations should be replaced by a suitable approach that is accurate, inclusive, and standardized in every laboratory in the United States," write Paul M. Palevsky, MD, president of the National Kidney Foundation (NKF), and Susan E. Quaggin, MD, president of the American Society of Nephrology (ASN), in a joint statement.

They sent the statement in a "Dear Colleague" email on March 5 to about 25,000 members of both organizations.

Commitment to Ensuring Racial Bias Doesn't Affect Kidney Disease Care

"We are not suggesting that the correct approach is to simply remove the race coefficient from the current equations," stressed Palevsky in an interview. He also highlighted that "the issue of estimating equations is but one of many steps necessary to address racism and racial disparities in the care of people with kidney diseases, and that the NKF is committed as an organization to ensuring that racial bias does not affect the diagnosis and subsequent treatment of kidney diseases."

Use of a race coefficient to adjust the calculated eGFR of people who self-identify as Black first appeared in a 1999 revision of the eGFR formula, the Modification of Diet in Renal Disease study equation. The concept was perpetuated in an improved calculation formula, the Chronic Kidney Disease Epidemiology Collaboration, which came out a decade later. In both cases, the rationale was that these formulas systematically underestimate the value in Blacks.

In August 2020, the ASN and NKF formed a joint task force charged with examining "the inclusion of race in the estimation of GFR and its implications for the diagnosis and subsequent management of patients with, or at risk for, kidney disease." At that time, the two organizations anticipated making their report by the end of 2020.

The March 5 update notes that the task force has already submitted its interim report for publication and intends to submit its final report for publication before late June.

During 2020, some US health systems announced that they had eliminated routine reporting of eGFR using the race modifier or had strongly discouraged its use. These included the Massachusetts General Brigham system, in Boston, the University of Washington system, in Seattle, and the Vanderbilt University Medical Center system, in Nashville, Tennessee, as reported by Medscape Medical News.

However, momentum for these system-based changes in eGFR calculation slowed once the ASN and NKF announced formation of the task force. Most stakeholders now await release of the task force's report.

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