Elimination of race in estimates of kidney function to provide unbiased clinical management in Canada

Parekh, Rulan S.; Perl, Jeffrey; Auguste, Bourne L.; Sood, Manish M.

doi:10.1503/cmaj.210838

Cited by 8 publications

(3 citation statements)

References 14 publications

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“…The National Kidney Foundation (NKF) provides a set of risk factors for kidney disease, which include being 60 years of age or older, as well as identifying as Black, African American, Hispanic, or Latino (NKF, 2020). As of 2021, eGFR equations have been updated to remove race in order to reduce bias and improve precision and accuracy (Parekh et al, 2022). This may explain this study's observation that there is a positive influence of identifying as non-Hispanic Black on eGFR as compared to studies conducted before the equation adjustments.…”

Section: Discussionmentioning

confidence: 99%

Relationship Between Protein Types and hs-CRP on eGFR

Dispensa,

Andrade

2023

UFJUR

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Few studies have measured the relationship between protein types and inflammation on kidney function among US adults. The objective was to identify the relationship between protein types (animal, dairy, plant, seafood) and high-sensitivity C-reactive protein on estimated glomerular filtration rate (eGFR). A cross-sectional secondary analysis using NHANES 2017-2018 data was performed on 4252 adults with an eGFR of >15 ml/min/1.73m2. At least one 24-hour recall was used to categorize the protein type. Descriptives, frequencies, Pearson correlation, and multiple linear regressions were conducted using SPSS v28 with a significance of p<0.05. Participants were mostly female (50.1%), had a mean age of 50.1 years, and self-identified as non-Hispanic White (36.5%). A majority consumed animal and dairy products compared to seafood and plant products. A negative association was observed between consumption of plant proteins and inflammation on eGFR (p<0.05). In the adjusted regression model, non-Hispanic Black race had a positive influence on eGFR, while female and age had negative influences on eGFR (p < 0.001). Reduced consumption of plant proteins with elevated inflammation can decline kidney function. Future studies should focus on frequency and amount of proteins consumed and inflammation to reduce the progression of chronic diseases such as kidney disease.

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Section: Discussionmentioning

confidence: 99%

Relationship Between Protein Types and hs-CRP on eGFR

Dispensa,

Andrade

2023

UFJUR

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“…31 This correction ascribes an innate physiologic difference of kidney function by race, and has led to eligibility for organ transplants at a later stage of disease and, ultimately poorer health outcomes for Black people experiencing this illness. [31][32] This essentialist approach to race is not limited to the health sciences as it also pervades social sciences and humanities disciplines. In certain sociological and anthropological discourses, we have seen culture and ethnicity used as substitutes for biological determinants of health.…”

Section: Beyond Biomedical Constructs Of Race: Rejecting Essentialist...mentioning

confidence: 99%

Thinking ‘beyond’: critical reflections on race, racism, and the field of public health

Mbulaheni,

Sobers

2023

UTJPH

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The COVID-19 pandemic has deeply impacted all aspects of life in Canada, revealing systemic racism as a foundational issue perpetuating health and social inequalities for racialized communities. In the field of public health, there is a growing recognition that addressing racism is crucial for achieving health equity and that anti-racist work is public health work. As guest editors of this special issue, we emphasize that in order to achieve this goal, the public health community needs to think in the ‘beyond’. To think in the beyond is to name, reflect on and subvert the epistemological, methodological, and practical conventions that dominate public health. The authors reflect on key considerations in this regard that account for historical contexts of epidemiology’s methods, tools and practice, biomedical constructs of race, relationships of racialized power in sustaining health inequalities, whiteness as an object of critical analysis, and notions of legitimate knowledge in the quantitative-qualitative data continuum. We then provide a brief overview of each of the articles comprising this special issue and make connections to the ways they compel us to think in the ‘beyond’. By interrogating these considerations (and those exceeding this article), we can work towards a transformation of public health research, policy and practice, and the knowledge systems they are embedded within. The aim of this article is to underscore the urgent need to confront racism in public health and to reimagine and remake the field towards advancing health equity for racialized communities and for all.

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“…Although some papers are more circumspect [ 20 - 23 ], the systematic review identified fifty reviews, editorials, and commentaries in peer-reviewed journals [ 10 , 13 , 19 , 24 - 70 ] that argued for the abolition of race-based GFR cr estimation because Black race is: 1) a societal rather than biological construct [ 10 , 15 , 24 - 31 , 34 - 45 , 48 - 52 , 55 , 58 , 60 - 67 , 69 , 70 ]; 2) an imprecise proxy for genetic ancestry [ 13 , 24 - 26 , 29 , 31 , 43 , 44 , 46 - 50 , 60 - 65 , 67 , 70 ]; 3) poorly defined [ 10 , 13 , 19 , 34 , 39 , 43 , 44 , 48 - 52 , 55 , 62 , 63 , 67 - 69 ]; and 4) heterogeneous [ 10 , 26 , 29 , 30 , 34 , 35 , 44 , 46 , 52 , 66 , 67 ]. These articles also declared that the race correction: 5) lacked a physiological explanation [ 10 , 25 - 27 , 29 - 31 , 37 , …”

Section: Reviewmentioning

confidence: 99%

Retaining Race in Chronic Kidney Disease Diagnosis and Treatment

Williams

2023

Cureus

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The best overall measure of kidney function is glomerular filtration rate (GFR) as commonly estimated from serum creatinine concentrations (eGFR cr ) using formulas that correct for the higher average creatinine concentrations in Blacks. After two decades of use, these formulas have come under scrutiny for estimating GFR differently in Blacks and non-Blacks. Discussions of whether to include race (Black vs. non-Black) in the calculation of eGFR cr fail to acknowledge that the original race-based eGFR cr provided the same CKD treatment recommendations for Blacks and non-Blacks based on directly (exogenously) measured GFR. Nevertheless, the National Kidney Foundation and the American Society of Nephrology Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease removed race in CKD treatment guidelines and pushed for the immediate adoption of a race-free eGFR cr formula by physicians and clinical laboratories. This formula is projected to negate CKD in 5.51 million White and other non-Black adults and reclassify CKD to less severe stages in another 4.59 million non-Blacks, in order to expand treatment eligibility to 434,000 Blacks not previously diagnosed and to 584,000 Blacks previously diagnosed with less severe CKD. This review examines: 1) the validity of the arguments for removing the original race correction, and 2) the performance of the proposed replacement formula. Excluding race in the derivation of eGFR cr changed the statistical bias from +3.7 to -3.6 ml/min/1.73m 2 in Blacks and from +0.5 to +3.9 in non-Blacks, i.e., promoting CKD diagnosis in Blacks at the cost of restricting diagnosis in non-Blacks. By doing so, the revised eGFR cr greatly exaggerates the purported racial disparity in CKD burden. Claims that the revised formulas identify heretofore undiagnosed CKD in Blacks are not supported when studies that used kidney failure replacement therapy and mortality are interpreted as proxies for baseline CKD. Alternatively, a race-stratified eGFR cr (i.e., separate equations for Blacks and non-Blacks) would provide the least biased eGFR cr for both Blacks and non-Blacks and the best medical treatment for all patients.

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Elimination of race in estimates of kidney function to provide unbiased clinical management in Canada

Cited by 8 publications

References 14 publications

Relationship Between Protein Types and hs-CRP on eGFR

Relationship Between Protein Types and hs-CRP on eGFR

Thinking ‘beyond’: critical reflections on race, racism, and the field of public health

Retaining Race in Chronic Kidney Disease Diagnosis and Treatment

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