Hospital Initiative to Combat Chronic Kidney Disease Disparities

Phoenix, Arizona-based Dignity Health St. Joseph’s Hospital and Medical Center launched a new initiative this week to address the use of race-based algorithms in the early diagnosis of chronic kidney disease (CKD) and combatting health disparities.

The initiative is led by the nonprofit hospital chain CommonSpirit Health, of which St. Joseph’s is a member. It is designed to help improve health equity and outcomes for Black patients. Diagnosing kidney disease can be complicated by the use of biased assessment tools, such as the estimated glomerular filtration rate (eGFR).

eGFR is a standard tool used to diagnose CKD that leverages multiple factors, such as patient age, race, and lab test results, such as serum creatinine levels. Prior research showed that Black Americans have higher levels of serum creatinine in their blood, independent of kidney function, compared to their White counterparts. This led clinicians to use a “race correction” multiplier when calculating eGFR.

However, National Institutes of Health (NIH)-supported research suggests that there is no scientific basis for including race within the algorithm. The research further notes that including it as an assessment factor can result in care delays and worsen clinical outcomes for Black and other minoritized patients, according to the press release.

As part of the initiative, known as the Equity Heals: Addressing Chronic Kidney Disease initiative, CommonSpirit Health will remove race from eGFR calculations to correct disparities in early diagnosis of CKD. Doing so has been shown to improve bias, accuracy, and precision in eGFR equations used on Black adult patients in recent studies.

“This transition marks the beginning of ensuring that patients across our communities have access to equitable care without the influence of systemic social barriers such as race,” said Gaye Woods, system vice president of equity and inclusion for CommonSpirit Health, in the press release.

St. Joseph’s is set to serve as a learning site for the initiative, tasked with measuring the implementation of the new eGFR formula and launching a community outreach program focused on CKD disparities impacting its Black patient population.

“St. Joseph’s is proud to be part of this groundbreaking initiative, which will lead to improved outcomes for patients with chronic kidney disease, regardless of their race,” says Victor Waters, MD, chief medical officer at St. Joseph’s, in the press release. “This is a critical step in achieving health equity for all.”

The initiative will be scaled across CommonSpirit Health’s network, which spans over 1,000 care sites and 140 hospitals in 21 states.

These efforts come less than two years after a 2021 joint report released by the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) Task Force outlined a race-free approach to diagnosing CKD.

In the report, the organizations recommended the adoption of the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) creatinine equation and the increased use of cystatin C and serum creatinine to assess kidney function, which may report a different eGFR and change the CKD stage status for some patients, leading to potential improvements in clinical care.