December 12, 2023

For almost two years, everyone has ignored an important “health equity” story affecting 87% of Americans. It concerns the medical definition of chronic kidney disease (CKD), which is an impairment of the kidney’s ability to filter waste, toxins, and excess fluids from the blood. Affecting approximately 37 million US adults, the disease can lead to dialysis, kidney replacement, and death.

‘); googletag.cmd.push(function () { googletag.display(‘div-gpt-ad-1609268089992-0’); }); document.write(”); googletag.cmd.push(function() { googletag.pubads().addEventListener(‘slotRenderEnded’, function(event) { if (event.slot.getSlotElementId() == “div-hre-Americanthinker—New-3028”) { googletag.display(“div-hre-Americanthinker—New-3028”); } }); }); }

Physicians and health care providers rely on laboratory measurements of glomerular filtration rate (GFR) to diagnose CKD and to qualify patients for treatment, Medicare-paid education, referrals to a nephrologist (kidney specialist), and kidney transplants. GFR is usually estimated from a chemical in the blood called “creatinine.” High creatinine levels signify that the kidneys are not functioning well. Nearly 250 million creatinine measurements are made each year in the US.

On average, blacks have higher creatinine levels than non-blacks with the same kidney function. Their higher creatinine levels may arise because blacks in America have greater average muscle mass than non-blacks.

For over two decades, the formulas used to estimate GFR have included a correction for the higher creatinine concentrations in blacks in order to obtain the very best estimate of their directly measured GFR (the gold standard of kidney function.) This correction factor increased black GFR between 16% and 21%.

Image: Black and white healthcare providers by freepik.

‘); googletag.cmd.push(function () { googletag.display(‘div-gpt-ad-1609270365559-0’); }); document.write(”); googletag.cmd.push(function() { googletag.pubads().addEventListener(‘slotRenderEnded’, function(event) { if (event.slot.getSlotElementId() == “div-hre-Americanthinker—New-3035”) { googletag.display(“div-hre-Americanthinker—New-3035”); } }); }); }

One might assume that CKD and GFR would be defined with scientific impartiality. However, one consequence of the race adjustment is that, at the same blood creatinine level, a black patient might not receive the same kidney treatment as a non-black patient. Thus, whites with lower creatinine numbers will receive medical intervention, while blacks will not.

This has led medical students and physicians-turned-activists to cry discrimination. Activists collected petitions at major hospitals calling to remove the race correction. Medical journals published no fewer than fifty commentaries, editorials, and articles calling for its abolition. Print and internet news articles dutifully reported that the formulas were racist.

There was little published opposition once the race correction was framed as a civil rights issue. Scientists’ reticence to speak out was not unexpected, given that research funding requires nearly unanimous endorsement from the National Institutes of Health (NIH), and no scientist can risk alienating even one grant reviewer.

The government also became involved. In a 2020 letter to the Agency for Healthcare Research and Quality, senators Elizabeth Warren, Ron Wyden, and Cory Booker and Representative Barbara Lee expressed their concerns that GFR race-correction and other race-based algorithms risked embedding racism into medical practice. That year, Ways and Means Committee Chairman Richard E. Neal (D-MA) sent letters to the American Society of Nephrology (ASN) and other medical organizations questioning their use of race in clinical algorithms.

Importantly, none of the petitions, none of the government actions, and none of the medical and news articles acknowledged one simple fundamental fact: blacks and non-blacks received exactly the same diagnosis and medical treatment based on their very best estimate of directly measured GFR (the gold standard, which is not necessarily the same as laboratory creatinine measurements.)

Nevertheless, in response to pressure from students, activists, and Congress, the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) redefined GFR (kidney function) by recalculating the GFR formula without the race correction. The only reasons given for this change were that “race is a social, not a biological construct” and that race, as used in the original equations, ignores “the substantial diversity within self-identified black or African American patients and other racial or ethnic minority groups.” Notably, the organizations did not provide any evidence of improved health outcomes.