Calls to remove race as a factor in calculating eGFR (estimated glomular filtration rate) are growing across the United States. The use of race in the equation is based on unfounded assumptions that African Americans have on average higher muscle mass than whites. There is no evidence that this is the case.
Using race to calculate eGFR has major consequences for African American patients when the equation results in higher eGFRs for patients who are identified as black. Disparities in access to kidney transplantation are one example. A patient must have an eGFR of less than 20mL/min/1.73m2 to qualify for the waitlist for kidney transplantation. Using standard equations for eGFR, two patients identical except for assigned racial category may have very different outcomes if they both have a creatinine level of 2.8 mg/dL – a white patient would be placed on the waitlist but a black patient would be ineligible.
What did we do?
Our CMO, also a family physician faculty member in the residency program took this information to the hospital lab director and medical director of pathology and asked for race to be removed from the calculation for eGFR on lab results. She also discussed this issue with the larger hospital corporation, which is now considering removing this calculation in all hospitals corporation-wide. The change was made quickly and without dissention.
What did we learn?
Public discussion in major medical journals like the New England Journal of Medicine and across many medical professional organizations smoothed the way for rapid action. We also laid the foundation within our residency program to identify and act on institutional racism through placing health equity at the center of our curriculum. And we have leaders willing to act.