The University of Maryland Medical System will no longer take race into consideration when diagnosing chronic kidney disease, the system announced last week.
The blood test used at hospitals to evaluate whether a patient has kidney disease has long factored in whether a patient is Black or not — with Black patients appearing healthier than patients of other races, even if their bloodwork turns out the same results.
This is because kidney function is measured by testing for blood creatinine levels, and a 1999 study showed that Black people, on average, have higher creatinine levels than people of other races, even if kidney function is the same. The current test aims to adjust for this by adding to Black patients’ results, which often causes health professionals to overestimate the health of their kidneys. (The test also accounts for age and sex).
This practice has been harshly criticized in recent years for resulting in Black people being underdiagnosed for kidney disease, effectively shuttering them from receiving lifesaving treatments like dialysis and kidney replacements.
But now, hospitals are beginning to leave this diagnostic method behind, following recommendations from the National Kidney Foundation and the American Society of Nephrology to begin using a new equation to assess kidney function — one without the race coefficient.
In the UMMS, hospitals plan to switch to the new diagnostic equation by January. The new formula will include measuring both the patients’ creatinine levels as well as their levels of cystatin C, a protein that can help predict kidney function. Research in the New England Journal of Medicine showed that an equation that incorporated both creatinine and cystatin C — and did not take race into consideration — was more accurate than new equations based on just creatinine or just cystatin C levels.
“This is a significant development for University of Maryland Medicine and for academic medicine in general,” Mohan Suntha, president and CEO of UMMS, said in a press release. “We are in a period of evolution toward truly understanding the scope and impact of race-based disparities in health care and taking steps to address inequities. I commend our physician leadership and University of Maryland School of Medicine partners who have taken swift and decisive action to operationalize this change across our System hospitals, programs and clinical partners. We are proud to be among the nation’s first academic medical systems leading this imperative.”
The university system joins the likes of University of California, Davis, Vanderbilt University and the University of Washington — the latter of which dropped race from kidney function calculations nearly a year and a half ago — in making this switch.
One estimate shows that 720,000 Black Americans nationwide could be treated earlier for kidney disease if race were not factored into the diagnosis. In Maryland, the number could be in the thousands, according to UMMS. This is especially significant considering Black Americans are three times more likely than people of other races to experience kidney failure, according to the health system’s announcement.
UMMS is currently working to implement the change.
“We are working expeditiously, but responsibly to take race out of the equation,” said Stephen Seliger, associate professor in the Division of Nephrology at UMSOM and an attending nephrologist at UMMC, in a press release. “But, anytime we advance change, we need to make sure we are not introducing unintended consequences. We have engaged a multidisciplinary team to develop a roadmap that will ensure a strong degree of accuracy in our evaluation of chronic kidney disease and its severity for all patients. We also want to ensure that our systems, internal and external stakeholders are all aligned. While the shift in the numbers seems small, the implications are not trivial. The elimination of race-based adjustments will alter reality for many of our patients.”
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