Imagine, your doctor suspects that you have a problem with your kidneys . So, he asks you to take a blood test to check your kidney function. You would be surprised if he told you that the number on that report varies depending on your ethnicity, wouldn't you? "How does my kidney function vary depending on my ethnicity?" You might be wondering. This is actually a big problem that has been going on in the world of medicine for a long time, and it is now being corrected. Today we are going to talk about it.
What is this equation that measures kidney function?
Our kidneys are like two of the most powerful filters in the body. The main function of the kidneys is to filter out unnecessary waste products from the blood and keep the body clean. So, one of the main measurements that doctors use to check the health of the kidneys is eGFR . That stands for estimated Glomerular Filtration Rate .
Simply put, it measures how quickly and efficiently your kidneys are cleaning your blood. Because it's hard to measure this directly, we estimate it using a mathematical equation that uses things like the level of a waste product called creatinine in your blood, your age, and your gender.
A decreasing eGFR value indicates that the kidneys are failing. This value is a key factor that helps doctors decide whether a person needs to start dialysis or undergo a kidney transplant.
Where did the problem start? How did 'race' become a factor?
For a while, there was a surprising variable in this eGFR equation: 'race' . But this didn't apply to all races. It only applied if someone identified as a "Black person."
That is, a white person and a black person of the same age, gender, and creatinine level received two eGFR values. If the black person was a white person, the equation artificially inflated that value.
What happened? The eGFR showed that a black person's kidney function was better than it actually was. As a result, they were delayed in getting the treatment they needed, such as starting dialysis or being put on the kidney transplant list. This was a huge, unintended injustice.
| Old eGFR equation (including race) | New eGFR equation (ethnicity-free) |
|---|---|
| Creatinine level, age, gender and 'race' (whether black or not) were considered in the calculation. | 'Race' has been completely removed from the calculation. Now only creatinine level, age and gender are considered. |
| It was shown that eGFR values in black patients were artificially increased. | Calculates eGFR in a more equitable manner, using the same measurement for patients of all ethnicities. |
| This has led to inequities and delays in prescribing treatment and scheduling kidney transplants. | Helps reduce disparities in referrals for medical care. |
Why was the word 'nation' included from the beginning?
This is due to research conducted in the 1990s. A study conducted at that time (Modification of Diet in Renal Disease – MDRD study) found that black people had higher blood creatinine levels than white people. They attributed this to an old, now scientifically challenged belief that “black people generally have more muscle mass than white people.”
At that time, including black people in research was considered a big deal, but today we understand that 'race' is not a biological thing, but a social construct.
“When we teach our medical students race-based equations, we instill in them the false notion that race is a biological determinant of disease. But it is not,” says Dr. Paul Palewski, president of the National Kidney Foundation.
The journey to correct this mistake
Fortunately, in recent years, medical students, doctors, nephrologists , and patient rights activists have begun to question this issue. “If there is no biological basis for this, why do we treat blacks and non-blacks differently?” they asked.
As a result, the National Kidney Foundation and the American Society of Nephrology joined forces to form a task force of patients, scientists, and physicians. As a result of their hard work, in 2021, two new eGFR equations were introduced to the world that completely removed the 'race' factor .
1. First equation: Same as the old one, only uses creatinine level (but without 'race').
2. Second equation: In addition to creatinine levels, another chemical marker called cystatin C is also used. Although this is more accurate, the first equation is also recommended because the cystatin C test is not available in all laboratories in the world and is expensive.
This change is happening very rapidly in the medical field around the world. It is truly exciting that a decade-long change is happening in just a few months.
Why is this difference important to us?
You might think, this is an American problem, what does it matter to us? But medicine is a global thing. A scientific breakthrough or correction that occurs in one part of the world affects the entire world.
- Fairer Treatment: This ensures the right of a patient, anywhere in the world and of any nationality, to receive a fairer and more accurate diagnosis.
- Correcting mistakes in medicine: This is a prime example of how medicine is a field that is constantly renewing itself and correcting its own mistakes.
- Listening to the patient's voice: The voice of the patient was also a strong factor in making this change. This shows how important it is to listen to the opinions of patients, rather than the medical community alone making decisions.
Of course, changing this equation won't eliminate all health inequalities overnight. There are many social and economic factors that contribute to them. But this is a very strong and important step in that direction.
If you or someone you know has kidney disease, talk openly with your doctor about your medical tests and treatment. Ask them about your eGFR, what it means, and the best treatment options for you.
Take-Home Message
- eGFR (estimated Glomerular Filtration Rate) is an important calculation that measures kidney function.
- The previously used eGFR equation factored 'race' (especially for blacks) into the equation, resulting in unfair treatment and delays for patients.
- With the understanding that 'race' is not a biological factor, but a social concept, new, more fair eGFR equations have now been introduced that do not include 'race'.
- This change is an important step towards reducing inequalities in healthcare and providing fair treatment to all patients.
- If you have any concerns about your medical records and treatment, it is very important to talk about it openly and clearly with your doctor.
Kidney disease, eGFR, creatinine, kidney tests, health inequalities, medicine, kidney disease
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