Racialized algorithms for kidney function: Erasing social experience

Braun, Lundy; Wentz, Anna E.; Baker, R. Stanley; Richardson, Ellen; Tsai, Jennifer

doi:10.1016/j.socscimed.2020.113548

Cited by 42 publications

(37 citation statements)

References 63 publications

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“…14 Probing the Rationale for a Race Coefficient Although the biological rationale for including coefficients (such as age, sex, and body weight) in eGFR equations seem apparent, the reasons for including race on the basis of serum creatinine observational data, muscle mass, and/ or other factors are questionable. 15 It may be problematic to rely on a correction without completely understanding what factors are being captured together, and with an underappreciation of the ancestral diversity among African Americans that also exists in other racial and ethnic groups. 16 There is well-known exploitation and inhumane experimentation to which racial and ethnic minority individuals, particularly African Americans, have been subjected.…”

Section: Evolution Of Kidney Function Estimating Equationsmentioning

confidence: 99%

Reassessing the Inclusion of Race in Diagnosing Kidney Diseases: An Interim Report From the NKF-ASN Task Force

Delgado

Baweja

Burrows

et al. 2021

American Journal of Kidney Diseases

102

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For almost 2 decades, equations that use serum creatinine, age, sex, and race to estimate glomerular filtration rate (GFR) have included "race" as Black or non-Black. Given considerable evidence of disparities in health and health care delivery in African American communities, some regard keeping a race term in GFR equations as a practice that differentially influences access to care and kidney transplantation. Others assert that race captures important non-GFR determinants of serum creatinine and its removal from the calculation may perpetuate other disparities. The National Kidney Foundation (NKF) and American Society of Nephrology (ASN) established a task force in 2020 to reassess the inclusion of race in the estimation of GFR in the United States and its implications for diagnosis and subsequent management of patients with, or at risk for, kidney diseases. This interim report details the process, initial assessment of evidence, and values defined regarding the use of race to estimate GFR. We organized activities in phases: (1) clarify the problem and examine evidence, (2) evaluate different approaches to address use of race in GFR estimation, and (3) make recommendations. In phase 1, we constructed statements about the evidence and defined values regarding equity and disparities; race and racism; GFR measurement, estimation, and equation performance; laboratory standardization; and patient perspectives. We also identified several approaches to estimate GFR and a set of attributes to evaluate these approaches. Building on evidence and values, the attributes of alternative approaches to estimate GFR will be evaluated in the next phases and recommendations will be made.Complete author and article information provided before references.

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Section: Evolution Of Kidney Function Estimating Equationsmentioning

confidence: 99%

Reassessing the Inclusion of Race in Diagnosing Kidney Diseases: An Interim Report From the NKF-ASN Task Force

Delgado

Baweja

Burrows

et al. 2021

American Journal of Kidney Diseases

102

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“…Inaccurate assumptions of race-based differences in physiology and pathology, such as differences in sensation of pain, pulmonary function, and kidney function, continue to be perpetuated in medical literature and built into metrics for race corrections or “ethnic adjustments” in medical calculators. 75 , 76 , 77 As recently as 2005, the US Food and Drug Administration approved a race-specific drug called BiDil to treat heart failure in Black Americans, despite lack of comparison with other racial groups. 78 , 79 , 80 , 81 Differences found between racial categories in research studies may be inaccurate due to poorly defined standards for categorizing race and should be understood as social or geographic differences rather than biological ones.…”

Section: Policy Levelmentioning

confidence: 99%

The Time Is Now: Racism and the Responsibility of Emergency Medicine to Be Antiracist

Franks

Gipson

Kaltiso

et al. 2021

Annals of Emergency Medicine

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The COVID-19 pandemic has shed light on the ongoing pandemic of racial injustice. In the context of these twin pandemics, emergency medicine organizations are declaring that “Racism is a Public Health Crisis.” Accordingly, we are challenging emergency clinicians to respond to this emergency and commit to being antiracist. This courageous journey begins with naming racism and continues with actions addressing the intersection of racism and social determinants of health that result in health inequities. Therefore, we present a social-ecological framework that structures the intentional actions that emergency medicine must implement at the individual, organizational, community, and policy levels to actively respond to this emergency and be antiracist.

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“…In the past several years, numerous institutions have decided to end reporting of the race modifier used in kidney care because of these concerns. Health equity researchers have described how the race modifier normalizes racial difference in ways that advances racial stigmatization and bias (9). Misuse of race in other clinical algorithms, like the vaginal birth after cesarean calculator and pulmonary function tests, among others, faces critique for similar reasons (10).…”

mentioning

confidence: 99%