NICE takes ethnicity out of estimating kidney function

Towards equations for estimating glomerular filtration rate without demographic characteristics

“…For estimating GFR, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) research group recently proposed two new serum creatinine-based equations without race, eGFRcr(AS) and eGFRcr-cys(AS), to replace the widely used equations eGFRcr(ASR) and eGFRcr-cys(ASR), that considers serum creatinine, cystatin C (CysC), age, sex and race. [1][2][3][4] The new equations were developed and validated using data mainly from White and Black participants. 4 It remains unknown whether they are applicable to plasma samples as well as to non-White and non-Black subjects.…”

Time to end the misuse of race in medicine: cases from nephrology

“…The most widely used methods in adults are the Modification of Diet in Renal Disease (MDRD) equation and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation 8. Numerous US institutions and NICE in the UK, have rejected the use of race in the equations4910 as it perpetuates the biological myth that Black people have a 16% higher eGFR (the coefficient in CKD-EPI is 1.159) based on the belief they have higher muscle mass than white people 11. Though the newer CKD-EPI equation performs better than the older MDRD equation, concordance of estimated and measured GFR improved only slightly (from 64% to 69%), showing there is still substantial error in estimating GFR.…”

“…Use of a flawed interpretation of race has inhibited the investigation of race associated differences in health outcomes and probably led to health inequalities in numerous areas of medicine 3. In the UK, for example, the National Institute for Health and Care Excellence (NICE) recently recommended that doctors no longer adjust for race when estimating glomerular filtration rate because it contributed to inequalities 4. Recurring themes throughout medicine include the view of race as an innate biological variable predictive of health when in fact it is socially constructed, with health consequences that are largely biological manifestations of structural racism,56 and the obsessive focus on gene frequencies across racial groups to explain disparities while ignoring the much larger effect of socioeconomic deprivation and racial discrimination 5…”

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

“…In 2021, new equations that omit race but include other factors were developed and found to be more accurate in estimating eGFR, 1 and the US National Kidney Foundation, American Society of Nephrology Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Diseases and the UK National Institute for Health and Care Excellence recommended the removal of race from the calculation of eGFR. 2 , 3 We discuss why the inclusion of race in kidney function estimates is biased and harmful, and why swift adoption of calculations that omit race is important in clinical care in Canada.…”