Question special

Thank you all for the thoughtful discussion thus far! For day 7, we will be discussing race-adjusted algorithms as described in the article “Hidden in Plain Sight.”

Clinical calculators and algorithms are essential to our everyday practice of medicine. To start us off, it is worth considering one of the most ubiquitous race-based clinical tools: the adjusted estimated glomerular filtration rate (eGFR) for black patients. Continued use of this race-based adjustment has the potential to exacerbate existing healthcare disparities in ESRD outcomes, nephrology specialist referral patterns, and kidney transplantation. However, some studies that suggest non-race adjusted eGFR underestimates true GFR for black patients, thus potentially leading to overtreatment of CKD, inappropriate antibiotic dosing, and exclusion from clinical trials.

The American Society of Nephrology recommends continued use of race-adjusted eGFR until robust data is available to more accurately estimate GFR independent of race. Do you agree with this recommendation?

How could we envision a more equitable derivation of the eGFR algorithm in the first place? Would the inclusion of more nonwhite patients and/or consideration of social determinants of health have mitigated the need to include an adjustment for race?