Dropping race from test helps Black Americans get kidney transplants
In a groundbreaking effort several years ago, nephrologists took a bold step to remove race from a crucial clinical algorithm in an attempt to address the harms caused by a race-based equation that was negatively impacting patients. The equation used to calculate eGFR, a measure of kidney function, had been inflating results for Black patients by up to 21%, which could mask severe kidney disease and delay life-saving transplants. The decision to phase out the race-based equation in 2022 was followed by a mandate from the Organ Procurement and Transplantation Network for transplant programs to submit modifications specifically for Black patients awaiting transplants.
A recent study revealed the significant impact of this change, with 27% of Black patients being affected and resulting in 5.3 more transplants per 1000 Black candidates. LaVarne A. Burton, president and CEO of the American Kidney Fund, emphasized the meaningfulness of these results for the thousands of individuals who have benefited from the wait time modifications implemented as a result of the policy change.
The process of removing race from the eGFR equation was met with resistance and division within the nephrology field. Despite the National Kidney Foundation’s task force voting to eliminate race from the equation, many tools in the medical field still incorporate race as a variable. Vanessa Grubbs, a nephrologist and internist, noted the contentious nature of the debate surrounding the race-neutral equation, highlighting the evidence that it has helped mitigate disparities in kidney disease.
The study evaluating the impact of the OPTN policy change compared transplant data before and after its implementation in 2023, involving over 180,000 candidates, including 56,000 Black individuals. Surprisingly, the study found that non-Black patients did not experience a decrease in transplant rates, challenging concerns that improving transplant rates for Black individuals could detract from other patients. While the policy change had the intended effect, it did not completely resolve racial disparities in kidney transplantation, with variations in wait time adjustments based on where Black candidates received care.
Moving forward, there is a need to address other inequities in kidney disease and explore opportunities for implementing policies aimed at racial equity. Health services researcher and Boston Medical Center resident physician Rohan Khazanchi has been advocating for similar policies in other areas, such as remedying the effects of race-based lung tests that impact worker compensation payouts. By continuing to address racial disparities in healthcare policies, there is hope for a more equitable and just healthcare system for all individuals.
