Task force recommendations on eGFR pose first step toward equity
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The health care community has been grappling with ways to improve equity in patient care, and the dialysis and kidney transplant profession has been part of the effort.
Last month, a joint task force of the National Kidney Foundation and the American Society of Nephrology – formed more than a year ago – released its final report1 on considering race in the diagnosis of kidney disease and outlined an approach that recommends adoption of a new equation that estimates kidney function without a race variable.
The report, published online in the American Journal of Kidney Diseases and the Journal of the American Society of Nephrology, was drafted with “input from the medical community and patients to identify an approach that balanced social justice with scientific rigor,” Cynthia Delgado MD, FASN, associate professor of medicine, San Francisco Veterans Affairs Healthcare System and University of California, San Francisco, and co-chair of the joint NKF-ASN task force, said in a press release.
Recommendations
In the paper, of which she served as lead author, Delgado and colleagues made the following recommendations:
- for adults in the United States, 85% of whom have normal kidney function, clinicians should “implement use of the [Chronic Kidney Disease Epidemiology Collaboration] CKD-EPI creatinine equation refit without the race variable in all laboratories in the U.S. because it does not include race in the calculation and reporting, includes diversity in its development, is immediately available to all labs in the U.S., and has acceptable performance characteristics and potential consequences that do not disproportionately affect any one group of individuals,” the authors wrote;
- national efforts should be made to “facilitate increased, routine and timely use of cystatin C, especially to confirm eGFR in adults who are at risk for or have chronic kidney disease, because combining filtration markers (creatinine and cystatin C) is more accurate and would support better clinical decisions than either one marker alone;” and
- that “research on GFR estimation with new endogenous filtration markers and on interventions to eliminate race and ethnic disparities should be encouraged and funded,” Delgado and colleagues wrote.
Equity in care
The recommendation by the task force “is an important step forward in assuring health and health care equity ... The NKF and ASN urge all laboratories and health care systems nationwide to adopt this new approach as rapidly as possible so that we can move toward a consistent method of diagnosing kidney diseases that is independent of race,” Paul M. Palevsky, MD, FASN, FNKF, NKF president said in the release.
The accomplishments of the task force are a good start toward a goal of making sure that every individual with kidney disease is treated equitably. As part of that effort, CMS has proposed a package of changes to the ESRD Treatment Choices (ETC) model for 2022 that offers dialysis clinics additional financial rewards if the clinics show a provision of equity in home dialysis and transplant care.
In the proposal, a “health equity incentive” to the improvement scoring methodology for both the home dialysis rate and the transplant rate would be offered to dialysis clinics that demonstrate significant improvement in rates of home dialysis or transplantation among beneficiaries who are dual-eligible for Medicare and Medicaid or low-income subsidy (LIS) recipients. Also, a re-stratification of achievement benchmarks by the proportion of beneficiaries who are dual-eligible for Medicare and Medicaid or are LIS recipients for ETC clinics that see a high volume of these patients would not face negative financial consequences as a result.
Palevsky agreed more work lies ahead. “While the work of the task force is an important initial path forward, both of our organizations are committed to continuing to work to eliminate disparities in the diagnosis and treatment of kidney disease,” he said.
- References:
- Delgado C, et al. Am Jrnl of Kid Dis. 2021;doi:10.1053/j.ajkd.2021.08.003.
- www.healio.com/news/nephrology/20210816/cms-proposes-changes-to-esrd-treatment-choices-model-to-improve-equity-of-care. Published Sept.16, 2021. Accessed Sept. 26, 2021.
- www.kidney.org/news/nkf-and-asn-release-new-way-to-diagnose-kidney-diseases. Published Sept. 23, 2021. Accessed Sept. 26, 2021. For more information:
- Mark E. Neumann is the editor-in-chief of Nephrology News & Issues and can be reached at mneumann@healio.com.