A simple metric that uses a blood test, plus the patient’s age and sex and whether they’re Black or not makes Black patients appear to have healthier kidneys than non-Black patients, even when their blood measurements are identical. “It is as close to stereotyping a particular group of people as it can be,” said Rajnish Mehrotra, a nephrologist with the University of Washington School of Medicine.
This race coefficient has recently come under fire for being imprecise, leading to potentially worse outcomes for Black patients and less chance of receiving a new kidney. A national task force of kidney experts and patients is studying how to replace it. Some institutions have already stopped using it. Some medical experts say fixing this equation is only one step in creating more equitable care, a process complicated by factors far deeper than a math problem.
The racial part of the equation
Buoyed by activism around structural racism*, those seeking equity in health care have recently been calling out the algorithm as an example of the racism baked into American medicine. Researchers writing in the New England Journal of Medicine last year included kidney equations in a laundry list of race-adjusted algorithms used to evaluate parts of the body — from heart and lungs to bones and breasts. Such equations, they wrote, can “perpetuate or even amplify race-based health inequities.”
Leaders in kidney care believe race modifiers should be removed, because it make black patients and their providers believe their kidneys are functioning 16 percent better than they actually are—which can lead to delayed care and limited access to more ideal treatment options.
Inaccurate race based equations cause black patients to get delayed referrals to specialist and they have to wait much longer to get on the transplant list. More specifically, it might not be that Black bodies are more likely to have more creatinine in the blood, but that Americans who experience housing insecurity and barriers to healthy food, quality medical care and timely referrals are more likely to have creatinine in their blood — and that many of them happen to be Black.
Systemic* health disparities help explain why Black patients have unusually high rates of kidney failure, since communities of color have less access to regular primary care. One of the most serious consequences of poorly controlled diabetes and hypertension is failure of the organ.
Direct discrimination — intentional or not — from providers may also affect outcomes. Studies recently published in the Journal of the American Medical Association and the Journal of the American Society of Nephrology noted that removing the race factor could lead to some Black patients being disqualified from using beneficial medications because their kidneys might appear unable to handle them. It could also disqualify some Black people from donating a kidney.
This article is an excerpt provided by Kaiser Health News and originally printed in The Washing Post, Tuesday, June 8, 2021
*Structural, institutional and systemic racism broadly refer to the “system of structures that that have procedures or processes that disadvantage African Americans.”