Reassessing the Inclusion of Race in Diagnosing Kidney Diseases: An Interim Report From the NKF-ASN Task Force

Cynthia Delgado, Mukta Baweja, Nilka Ríos Burrows, Deidra C. Crews, Nwamaka D. Eneanya, Crystal A. Gadegbeku, Lesley A. Inker, Mallika L. Mendu, W. Greg Miller, Marva M. Moxey-Mims, Glenda V. Roberts, Wendy L. St. Peter, Curtis Warfield, Neil R. Powe

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)103-115
Number of pages13
JournalAmerican Journal of Kidney Diseases
Volume78
Issue number1
DOIs
StatePublished - Jun 1 2021

Bibliographical note

Funding Information:
Cynthia Delgado, MD, Mukta Baweja, MD, Nilka R?os Burrows, MPH, MT, Deidra C. Crews, MD, ScM, Nwamaka D. Eneanya, MD, MPH, Crystal A. Gadegbeku, MD, Lesley A. Inker, MD, Mallika L. Mendu, MD, MBA, W. Greg Miller, PhD, Marva M. Moxey-Mims, MD, Glenda V. Roberts, BSc, Wendy L. St. Peter, PharmD, Curtis Warfield, MS, and Neil R. Powe, MD, MPH, MBA. Drs Delgado and Powe are cochairs of the NKF-ASN Task Force. None. Dr Delgado reports her contribution is in part supported with the resources and the use of facilities at the San Francisco VA Medical Center. Dr Baweja reports having interests/relationships with Physicians for Human Rights, Young Center for Immigrant Children's Rights, and Premier, Inc. Dr Crews reports serving on the Nephrology Board of the American Board of Internal Medicine, on the Council of Subspecialist Societies at the American College of Physicians, on the Bayer HealthCare Pharmaceuticals Inc, Patient and Physician Advisory Board Steering Committee for Disparities in CKD Project, on the editorial board of CJASN and JRN, 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). Dr Eneanya reports receiving honoraria from Columbia University Medical Center, Gerson Lehrman, Harvard University, Partners 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. Dr 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. Dr 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 Medical Center); and receiving research funding from NIH, NKF, Omeros, Retrophin, Reata, and Travere Therapeutics. Dr Mendu reports having consultancy agreements with Bayer AG. Dr Miller reports having consultancy agreements with Baebies; and receiving honoraria from, and being a scientific advisor for, or member of, Clinical Chemistry. Dr 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. Ms 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 Society of Nephrology Patient Group, University of Washington Center for Dialysis Innovation Patient Advisory Board, and University of Washington 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. Dr St. Peter reports receiving honoraria from American Nephrology Nursing Association, Integritas Group, and Optum Labs; and serving on the Centers for Medicare & Medicaid Services Technical Expert Panel on Development of a Quality Measure Assessing Delay in Progression of CKD, on the JASN technical expert panel for Quality Insights Kidney Care Pilot project; serving as a Scientific Advisory Board member of the NKF; and having consultancy agreements with Total Renal Care, Inc. Mr Warfield reports serving on the NKF Indiana Board of Directors and on the Home Dialyzors United Board of Directors. Dr Powe reports serving as a JASN associate editor and reports receiving honoraria from and serving as a scientific advisor for the Patient Centered Outcomes Research Institute, Robert Wood Johnson Foundation, University of Washington, Yale University, and Vanderbilt University. Ms R?os Burrows declares that she has no relevant financial interests. The authors thank Mr Killian Gause and Ms Riley Hoffman for assistance during the sessions. The authors thank the leadership of the NKF and ASN for their support of the Task Force. Ms R?os Burrows is with the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Received January 11, 2021, at JASN and AJKD. Evaluated by 4 external peer reviewers, with direct editorial input from a JASN Deputy Editor and an AJKD Acting Editor-in-Chief. Accepted in revised form by both journals March 5, 2021. The involvement of an Acting Editor-in-Chief was to comply with AJKD's procedures for potential conflicts of interest for editors, described in the Information for Authors & Journal Policies. Because Drs Moxey-Mims and Powe are Associate Editors of JASN, they were not involved in the peer-review process for this manuscript. Another editor oversaw the peer-review and decision-making process for this manuscript.

Funding Information:
Dr Delgado reports her contribution is in part supported with the resources and the use of facilities at the San Francisco VA Medical Center. Dr Baweja reports having interests/relationships with Physicians for Human Rights, Young Center for Immigrant Children’s Rights, and Premier, Inc. Dr Crews reports serving on the Nephrology Board of the American Board of Internal Medicine, on the Council of Subspecialist Societies at the American College of Physicians, on the Bayer HealthCare Pharmaceuticals Inc, Patient and Physician Advisory Board Steering Committee for Disparities in CKD Project, on the editorial board of CJASN and JRN, 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). Dr Eneanya reports receiving honoraria from Columbia University Medical Center, Gerson Lehrman, Harvard University, Partners 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. Dr 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. Dr 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 Medical Center); and receiving research funding from NIH, NKF, Omeros, Retrophin, Reata, and Travere Therapeutics. Dr Mendu reports having consultancy agreements with Bayer AG. Dr Miller reports having consultancy agreements with Baebies; and receiving honoraria from, and being a scientific advisor for, or member of, Clinical Chemistry. Dr 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. Ms 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 Society of Nephrology Patient Group, University of Washington Center for Dialysis Innovation Patient Advisory Board, and University of Washington 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. Dr St. Peter reports receiving honoraria from American Nephrology Nursing Association, Integritas Group, and Optum Labs; and serving on the Centers for Medicare & Medicaid Services Technical Expert Panel on Development of a Quality Measure Assessing Delay in Progression of CKD, on the JASN technical expert panel for Quality Insights Kidney Care Pilot project; serving as a Scientific Advisory Board member of the NKF; and having consultancy agreements with Total Renal Care, Inc. Mr Warfield reports serving on the NKF Indiana Board of Directors and on the Home Dialyzors United Board of Directors. Dr Powe reports serving as a JASN associate editor and reports receiving honoraria from and serving as a scientific advisor for the Patient Centered Outcomes Research Institute, Robert Wood Johnson Foundation, University of Washington, Yale University, and Vanderbilt University. Ms Ríos Burrows declares that she has no relevant financial interests.

Publisher Copyright:
© 2021 National KidneyFoundation, Inc and the American Society of Nephrology

Keywords

  • creatinine
  • estimated glomerular filtration rate (eGFR)
  • estimating equation
  • ethnicity
  • filtration marker
  • health care equity
  • health disparities
  • kidney disease
  • kidney disease diagnosis
  • laboratory medicine
  • medical decision making
  • patient-centered care
  • public health
  • race
  • race coefficient
  • racism
  • renal function
  • social determinants of health
  • United States
  • Health Status Disparities
  • Voluntary Health Agencies
  • Humans
  • Mathematical Concepts
  • Race Factors
  • Kidney Diseases/diagnosis
  • United States/epidemiology
  • Glomerular Filtration Rate
  • Healthcare Disparities
  • Advisory Committees/organization & administration

PubMed: MeSH publication types

  • Journal Article

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