Removing Race from Chronic Kidney Disease Diagnoses

The National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) Task Force released a report outlining a new race-free approach to diagnosing chronic kidney disease.

In the joint report published by the American Journal of Kidney Diseases (AJKD) and the Journal of the American Society of Nephrology (JASN), the NKF-ASN Task Force recommends the adoption of the new estimation of glomerular filtration rate (eGFR) 2021 Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) creatinine equation that estimated kidney function without including race as a variable.

Additionally, the task force recommends increasing the use of cystatin C combined with serum creatinine to confirm the assessment of GFR or kidney function. The new approach may report a different eGFR and could change the stage of kidney disease in some people.

While also addressing health disparities among racial and ethnic populations regarding chronic kidney disease, the new guidance assists with the diagnosis and management of patients and helps predict a patient’s risk of disease development. 

“Patients should learn their latest eGFR and uACR to assess if the new eGFR calculations change their kidney disease status or stage. Patients and healthcare professionals can use a patient-friendly eGFR calculator that uses the new equation to determine a non-race-based calculation to assess their kidney function. It is important for patients to speak with their doctors to determine if this may affect their treatment and care going forward,” the press release stated.

Over 37 million adults in the United States have chronic kidney disease, and 90 percent are not aware they have diminished kidney function. Disproportionately, racial and ethnic minorities populations are more heavily impacted.

For ten months, the NKR-ASN Task Force worked in three phases. The first clarified the problem and found evidence regarding eGFR equations in the United States.  Next, the task force evaluated different approaches to address the use of race in the GFR estimation. Lastly, the team provided recommendations.

The group found 26 approached for the GFR estimation and focused their efforts on five approaches.

“The final report was drafted with considerable input from hundreds of patients and family members, medical students and other trainees, clinicians, scientists, health professionals, and other stakeholders to achieve consensus for an unbiased assessment of GFR so that laboratories, clinicians, patients, and public health officials can make informed decisions to ensure equity and personalized care for patients with kidney diseases,” the press release stated.

According to the report, the challenges in the guidance implementation process are significant. However, medical societies, academic institutions, healthcare systems, and relevant industry partners must commit to these recommendations to ensure the best clinical approach for GFR assessment.