A “raceless” approach to diagnosing kidney disease

Thursday’s Scientific Task Force called for abandoning common measures of kidney function that tailored results by race and to provide black patients with a different assessment than other patients.

According to many experts, this adjustment may cause black patients to appear less ill than they really are. Instead, physicians should rely on race-neutral methods to diagnose and manage kidney disease, reports from the National Kidney Foundation and the American Society of Nephrology conclude.

Recommended specific equation Explained in a study published Thursday in The New England Journal of Medicine..

If adopted, the new approach will affect hundreds of millions of kidney function tests performed annually in hospital and outpatient settings, both in patients with acute illness and as part of regular screening blood tests. According to one estimate, one million African Americans may be treated for kidney disease early if the procedural formula is not tailored to race.

The task force report is American Journal of Kidney Disease And that Journal of the American Society of NephrologyIs in the midst of a national view of racial health inequalities caused by the Covid-19 pandemic.

“This issue is a moral issue,” said Dr. Neil R. Pow, Co-Chair of the Task Force and Director of Medicine at Zuckerberg San Francisco General Hospital and Trauma Center. “It’s time to get rid of race from the equation.”

Blacks and Hispanic Americans have long suffered from high rates of diabetes, high blood pressure, obesity, etc., which can exacerbate Covid attacks. These factors can also increase your risk of developing kidney disease.

Racial disparities in kidney disease are clear and well documented. Black Americans experience more than three times more renal failure than white Americans and may require dialysis or a kidney transplant.

African Americans make up only 13% of the population, but they Represents 35 percent Of Americans with renal failure. Over 90,000 Americans are on the kidney waiting list. Almost one-third is black, As many as whites.

Color and low-income Americans Less likely to receive good care When the first signs of warning appear and can prevent chronic kidney disease. The Centers for Medicare and Medicaid Services report that renal failure is more likely to progress to the need for dialysis and is less likely to be treated by a nephrologist before reaching that stage.

Black Americans too Wait for the organs For a variety of complex reasons, it is unlikely that your friends or relatives will donate your kidneys.

“This new recommendation ensures that racial prejudice is not introduced into clinical care, so it is no longer based on race and skin color determines the kidney care you receive,” said Nephrologist. Dr. Nwamaka Denise Eneanya, a doctor, said. A member of the University of Pennsylvania and the Task Force.

Her study is using current measurements to assess kidney function, which could underestimate the severity of the disease in black patients, delay referral to specialists, and be placed on the waiting list for kidney transplants. It suggests that it may be less sexual.

“Black individuals are inadvertently harmed because they are considered not ill enough,” said Dr. Eneaia.

Members of other task forces warned that the impact of changes on patient outcomes was uncertain and asked researchers to follow up to assess the impact.

The use of racial and ethnic medical decision-making tools is not unique to kidney disease. The algorithms and computers that doctors rely on to guide the diagnosis and treatment of many conditions, from bone density and kidney stones to cancer and respiratory function tests, include race as a variable. Outlined in the treatise It was published in the New England Journal of Medicine last year.

“Race is a social component, not a biological component,” said Dr. Winfred Williams, Deputy Chief of the Kidney Division at Massachusetts General Hospital in Boston. New equation editorial..

“It may serve as a substitute for other risk factors, including food insecurity, housing insecurity, and socio-economic deprivation. All of these can limit access to the best medical practices.”

In recent months, several medical societies have taken steps to address potential biases. May, American Academy of Pediatrics Officially dropped Clinical practice guidelines that take into account the race of the baby when assessing the risk of urinary tract infections.

The American College of Obstetricians and Gynecologists are currently updating algorithms that include racial and ethnicity in the computer used to assess the likelihood of a pregnant woman having a successful vaginal delivery after a previous caesarean section.

The authors said the new report, which reassessed the inclusion of race in the diagnosis of kidney disease, was published Thursday after a year of work and considerable controversy along the way.

The kidneys filter toxins from the blood. The new report uses a new equation to estimate filtration rates using a blood test that measures the level of creatinine, a waste product produced by muscles that are suppressed when the kidneys are functioning normally. It is recommended to do.

A related study, published Thursday in the New England Journal of Medicine and cited in the report, developed and evaluated a new diagnostic method that does not include race as a variable. Researchers have concluded that the new creatinine equation can be adopted soon.

However, the most accurate and race-neutral way to measure kidney filtration rate will incorporate blood tests that measure the levels of different markers: cells called cystatin C that rise when the kidneys are not functioning well. A protein produced by.

Testing for cystatin C is more expensive and not widely available, but experts have called for them to be more accessible and gradually increased in use.