A racially biased test that prevented thousands of Black people from receiving kidney transplants is finally changing.
For the past twenty years the estimated glomerular filtration rate (eGFR) clinical lab test used to be the gold standard in evaluating “how efficiently a person’s kidneys remove creatinine, a waste product they filter out of blood. The eGFR equation reports a score based on measured creatinine levels while also considering a patient’s age, gender, and race.”
Due to an automated formula that calculated results differently for Blacks and non-Blacks, the once widely used test overestimated how well the kidneys of Black people functioned, making them seem healthier than they really were. That overestimation could delay the diagnosis of organ failure and evaluation for a transplant, “exacerbated by other disparities that already make Black patients more likely to need a kidney transplant but less likely to receive it.”
But now “the U.S. organ transplant network ordered hospitals to use only race-neutral test results in adding new patients to the kidney waiting list.” Additionally, both the American Society of Nephrology and National Kidney Foundation have pushed laboratories to start using race-free equations when assessing kidney functions.
This is partly thanks to a Black nephrologist whose 2019 paper published in the Journal of the American Medical Association helped drive this issue to the forefront of the medical community. Assistant professor in Epidemiology and in Renal-Electrolyte and Hypertension at the Perelman School of Medicine Nwamaka Eneanya, MD, MPH has been working diligently to ensure that race is eliminated from the eGFR equation formula.
As Dr. Eneanya explained, “The researchers who developed these equations discovered that Black study participants had higher creatinine levels compared to white study participants — despite having similar kidney function….[and] they concluded that Black patients’ eGFR scores should be adjusted with a multiplication factor. Clinicians have been performing this ‘race correction’ for more than 20 years, so Black patients are routinely assigned higher kidney function than those of other races.”
This instance of medical racism heightened the disparities that have persisted for years. According to the National Kidney Foundation, “33% of American adults are at risk for kidney disease,” and “Black or African Americans are more than 3 times as likely…to have kidney failure compared to white Americans.” This is significant, given that kidneys are an important organ in the human body—“[t]hey remove waste products and extra water from your body, help make red blood cells, help keep your bones healthy and help control blood pressure.”
However “[t]he kidney saga is unique because of the effort to remedy a past wrong,” the Associated Press reports.
In an unprecedented “attempt at restorative justice: The transplant network gave hospitals a year to uncover which Black kidney candidates could have qualified for a new kidney sooner if not for the race-based test — and adjust their waiting time to make up for it.” In addition, newly listed Black patients will get this same treatment, to check if they should have been added or referred earlier.
These efforts seem to be paying off. During the three-month period between January to March 2023, there were more than 14,300 Black people in need of kidney transplants whose wait times were changed, averaging out to a two year time difference.