The University of Maryland Medical System (UMMS) and University of Maryland School of Medicine (UMSOM) recently announced an upcoming change to a long existing clinical standard that is expected to have a considerable impact on thousands of Black Americans.
By late January, UMMS will transition to a new standard of evaluating kidney function, eliminating whether a patient is “African American or non-African American” as a factor in determining eligibility for kidney transplantation or treatment.
For many years, medical practitioners— nephrologists in particular— used a metric to estimate glomerular filtration rate (eGFR), which reflects how well someone’s kidneys filter waste. The equation also relies on levels of creatinine, a byproduct of muscle and protein metabolism, from the blood to accurately assess and identify kidney disease.
“In addition to age and gender, the calculation takes into account whether a patient is ‘African American or non-African American’ and assigns a multiplier based in part on a discredited notion that Black people tend to have more muscle mass than people of other races,” a UMMS statement said. “This higher value often overestimates the health of Black patients’ kidneys, pushing them above the threshold for diagnosis of advanced kidney disease, and therefore, leading to delayed referral for specialty care, or even disqualification for kidney transplant.”
This groundbreaking shift is measured to increase access to specialty care, including eligibility for kidney transplantation for thousands of Black people living with advanced kidney disease.
UMMS’ and UMSOM’s decision to end the use of the international clinical standard that factors a patient’s race into the diagnosis of chronic kidney disease was lauded by nephrologist Stephen Seliger, MD and Roderick King, MD.
The presumption that individuals of African ancestry had higher levels of skeletal muscle was not based on verifiable facts, Seliger highlighted. For more than a year, he and his colleagues within the medical system have discussed the method they used to report and estimate kidney function.
“That assumption though, about differences in skeletal muscle, is not really ever supported by any good evidence. Even more so, it essentially made explicit the biological differences between the groups of people who describe themselves differently based on their ancestry,” said Dr. Seliger, who works with the University of Maryland Medical Center in downtown Baltimore. “Even though we recognize those differences can be very small and subtle in how people describe themselves in terms of their racial identity, is as much a factor of society and social factors as it is biology, physiology, genetics. And so it was that recognition that led to a reevaluation of this equation— to not have to require people to identify as any one specific race.”
UMMS’ decision was concurrent with a national effort led by the National Kidney Foundation and the American Society of Nephrology, who formed a joint task force to review the use of race in eGFR calculations.
In September, the task force endorsed a new calculation without the race coefficient. Shortly thereafter, a committee of UMMS and UMSOM researchers, kidney specialists, clinical quality leaders and health equity experts then convened to closely review the new guidance and develop a rapid way to implement the new equation.
“The reason for making these changes, as I mentioned, is it’s the right thing to do from a standpoint of social justice and from the standpoint of correcting long-standing, race-based mispercep- tions,” said Dr. Seliger, who is also an associate professor at UMSOM. “Our intent to look at, investigate and correct [other] race-based assumptions that are present in medicine certainly is a longer-term goal, but this is a first step in that overall process.”
According to a UMMS statement, approximately 720,000 Black Americans might be treated earlier for kidney disease if race didn’t factor into calculating kidney function. Locally, thousands could be impacted by this transition to race-free eGFR.
The National Kidney Foundation notes that of the one in three Americans who are at risk for kidney disease, Black Americans are almost four times as likely to experience kidney failure compared to their White counterparts.
“Even if it’s a Black doctor, there are ways that we assess certain diseases that inappropriately integrate race as a factor, and this particular one for GFR is one of many other race-based clinical policies or clinical assessments that we have in the field of medicine,” said King, the new chief diversity, equity and inclusion officer with UMMS. “Our plan, starting with GFR, is to dismantle all of these. We reviewed the literature, we are talking to our clinical colleagues at the medical school so this is a joint effort between the health system and the medical school to identify what these [race-based assessments are], and then remove them from how we clinically provide care to patients.”