NKF-ASN Task Force on race and eGFR publishes interim report
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Members of a joint task force established by the American Society of Nephrology and National Kidney Foundation presented an interim report on the removal of race as a factor in estimating GFR for patients with kidney disease.
“Why don’t we just think it terms of dropping race” when estimating GFR, Cynthia Delgado, MD, an associate clinical professor of medicine at the VA Medical Center in San Francisco and co-chair of the NKF-ASN Task Force, said at the National Kidney Foundation Spring Clinical Meetings, which was held as a virtual event. “The question is, ‘how would we drop race? What would be the steps?’”
Delgado was part of a group of speakers who provided a summary of the group’s interim report, “Reassessing the Inclusion of Race in Diagnosing Kidney Diseases: An Interim Report from the NKF-ASN Task Force.” The report, which was published online in the Journal of the American Society of Nephrology and the American Journal of Kidney Diseases, provides an essential review of the many challenges relative to identifying and implementing alternative methods to diagnosing kidney diseases.
Last month, ASN and NKF asserted that race modifiers should not be included in equations used to estimate kidney function, according to a joint press release released by ASN and NKF. ASN and NKF also stated current race-based equations should be replaced by a substitute that is accurate, representative, unbiased and provides a standardized approach to diagnosing kidney diseases.
In its final report, the NKF-ASN Task Force will recommend the best approach to replace the existing equations for estimating kidney function, according to the release.
“The interim report is the second in a three-step process: 1) agree to replace race-based equations; 2) review the many challenges relative to identifying and implementing alternative methods; and 3) recommend the best approach for replacing existing equations to accomplishing the goal NKF and ASN established in July 2020 to examine 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 diseases,” NKF and ASN said in the release.
NKF and ASN urge dialysis centers and nephrology practices not to make any changes to how they estimate kidney function until the task force provides its recommendation for the best approach to replace the existing equations for estimating kidney function.
“The use of race in clinical algorithms, such as for the estimation of GFR, normalizes and reinforces the misconception of race as a biological determinant of health and disease,” Paul M. Palevsky, MD, FASN, FNKF, NKF president, said in the release. “This is not to say that clinicians should ignore race and ethnicity. Doing so would blind us to the disparities and inequities present in health and health care. But we must not conflate the societal effects of race and racism on health, health care and kidney diseases with physiologic and pathophysiologic determinants of health,”
Susan E. Quaggin, MD, ASN president, said in the release. “Beyond the inclusion of race in clinical algorithms like eGFR, ASN and NKF assert that racism manifests in many aspects of health care. Both organizations commit to providing resources and expertise to the essential job of dismantling systemic racism in kidney care, research and education.”
The task force has set a deadline of April 30 for input on the interim report.
References:
Delgado C, Powe W. Session #252. Presented at: National Kidney Foundation Spring Clinical Meetings (virtual meeting); April 6-10, 2021.
Delgado C, et al. Am J Kidney Dis. 2021;doi:https://doi.org/10.1053/j.ajkd.2021.03.008.
Delgado C, et al. J Am Soc Nephrol;2021;doi:https://doi.org/10.1681/ASN.2021010039.
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