For almost two decades, equations that use serum creatinine, age, sex, and race to eGFR have included “race” as Black or non-Black. Given considerable evidence of disparities in health and healthcare delivery in African American communities, some regard keeping a race term in GFR equations as a practice that differentially influences access to care and kidney transplantation. Others assert that race captures important non GFR determinants of serum creatinine and its removal from the calculation may perpetuate other disparities. The National Kidney Foundation (NKF) and American Society of Nephrology (ASN) established a task force in 2020 to reassess the inclusion of race in the estimation of GFR in the United States and its implications for diagnosis and subsequent management of patients with, or at risk for, kidney diseases. This interim report details the process, initial assessment of evidence, and values defined regarding the use of race to estimate GFR. We organized activities in phases: (1) clarify the problem and examine evidence, (2) evaluate different approaches to address use of race in GFR estimation, and (3) make recommendations. In phase one, we constructed statements about the evidence and defined values regarding equity and disparities; race and racism; GFR measurement, estimation, and equation performance; laboratory standardization; and patient perspectives. We also identified several approaches to estimate GFR and a set of attributes to evaluate these approaches. Building on evidence and values, the attributes of alternative approaches to estimate GFR will be evaluated in the next phases and recommendations will be made.
Bibliographical noteFunding Information:
HealthCare Pharmaceuticals Inc, Patient and Physician Advisory Board Steering Committee for Disparities in CKD Project, on the editorial board of CJASN and Journal of Renal Nutrition, as associate editor for Kidney360 as cochair of Kidney360, and on the Board of Directors of the NKF of Maryland/ Delaware; receiving research funding from Somatus, Inc.; and having consultancy agreements with Yale New Haven Health Services Corporation Center for Outcomes Research and Evaluation (CORE). C. Delgado reports her contribution is in part supported with the resources and the use of facilities at the San Francisco VA Medical Center. N.D. Eneanya reports receiving honoraria from Columbia University Medical Center, Gerson Lehrman, Harvard University, Partner’s Healthcare, Quality Insights, SCAN Healthcare, University of California Irvine, and Wake Forest School of Medicine; serving as a scientific advisor for, or member of, Healthcare: The Journal of Delivery Science and Innovation and Kidney Medicine; and having consultancy agreements with Somatus. C. Gadegbeku reports receiving research funding from Akebia and Vertex; serving as scientific advisor for, or member of, the ASN Council; and having consultancy agreements with Fresenius Kidney Care as medical director. L.A. Inker reports serving as scientific advisor or member of, Alport’s Foundation, Goldfinch, and Diametrix; member of the ASN and member of National Kidney Disease Education Program; having consultancy agreements with Diamtrix and Tricidia(through Tufts MC); and receiving research funding from NIH, NKF, Omeros, Retrophin, Reata, and Travere Therapeutics. M.L. Mendu reports having consultancy agreements with Bayer AG. W. G. Miller reports having consultancy agreements with Baebies; and receiving honoraria from, and being a scientific advisor for, or member of, Clinical Chemistry. M.M. Moxey-Mims reports serving as associate editor for JASN, as an editorial board member of for Pediatric Nephrology, and on the scientific advisory boards of NephCure International and NKF. W.L. St. Peter reports receiving honoraria from American Nephrology Nursing Association, Integritas Group, and OptumLabs; and serving on the Centers for Medicare and Medicaid Services Technical Expert Panel on Development of a Quality Measure Assessing Delay in Progression of CKD, on the technical expert panel for Quality Insights Kidney Care Pilot project; and having consultancy agreements with Total Renal Care, Inc. N.R. Powe reports serving as a JASN associate editor; reports receiving honoraria from the Patient Centered Outcomes Research Institute, Robert Wood Johnson Foundation, University of Washington, Yale University, and Vanderbilt University; and serving as a scientific advisor for the Patient Centered Outcomes Research Institute, Robert Wood Johnson Foundation, University of Washington, Vanderbilt University, and Yale University. G.V. Roberts reports serving on a speakers bureau with American Association of Kidney Patients; receiving honoraria from APOLLO; serving on the APOLLO NIDDK Study Community Advisory Committee, Can-SOLVE CKD International Research Advisory Committee, International Nephrology Society (ISN) Patient Group, University of Washington (UW) Center for Dialysis Innovation Patient Advisory Board, and UW Kidney Research Institute Patient Advisory Committee; having other interests/relationships with the ASN COVID-19 Response Team and Transplant Subcommittee and Kidney Health Initiative Patient and Family Partnership Council; serving as an advisory committee member for Home Dialyzors United; and having ownership interest in Microsoft. C. Warfield reports serving on the NKF Indiana on the Board of Directors, and on the Home Dia-lyzors United Board of Directors. All remaining authors have nothing to disclose.
© 2021 by the American Society of Nephrology and the National Kidney Foundation, Inc. All rights reserved.
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