Ovetta Wiggins, Washington Post, November 17, 2021
Race-based algorithms have been used for decades to diagnose and decide treatment plans for kidney disease, lung disease, pregnancy and even dementia. Researchers looking at racial health disparities are now exploring how and when race is used in diagnostic tests — if they are warranted — and how they play a role in access to care and treatment.
The University of Maryland Medical System and the University of Maryland School of Medicine announced Wednesday that they will stop using the race-based diagnostic equation to estimate kidney function.
Advocates say the race-based equation in kidney disease is a likely factor in Black patients qualifying for transplantations later than they should.
In the Mid-Atlantic region, thousands of people could be affected by the change. The University of Maryland Medical System does not have an estimate of how many of its patients could possibly now qualify for transplantations.
The decision by the medical system and school follows a recommendation in September by a task force formed by the National Kidney Foundation and the American Society of Nephrology to reassess the use of race in diagnosing kidney disease. The panel recommended that all laboratories and health-care systems across the country adopt a race-free approach.
The current equation, which has been used since the late 1990s, relies on levels of creatinine — a byproduct of muscle and protein metabolism — from the blood. The calculation factors in age, gender and whether a patient is “African American or non-African American.”
“When the race modifier was included, it would appear your kidney function was better,” Susan E. Quaggin, president of the American Society of Nephrology, said in an interview. “You would be listed later for a kidney transplant.”
With the decision, the University of Maryland Medical System is joining a small but growing number of health systems and medical schools across the country, including the University of Washington, Mass General Brigham and Penn Medicine, in taking a step that advocates say will promote health equity.
Stephen Seliger, a nephrologist at the University of Maryland Medical Center and an associate professor at the University of Maryland School of Medicine, is working with a group to implement the change within the medical system. The new formula will go into effect in January.
Seliger said he wants to ensure that the change does not have unintended consequences.
“We are working expeditiously, but responsibly, to take race out of the equation,” he said.
Some research has questioned whether removing race could result in some patients not getting necessary medicines because their tests show their kidneys can’t handle them.
The initial move across the country to change the formula was initially sparked about five years ago by medical students who raised questions about using race in medical tests and the influence it can have on a patient’s treatment.
Paul Palevsky, president of the National Kidney Foundation, said the inclusion of race sends a “wrong message.”
“Race is a social construct; it is not a biological determinant of health or disease,” he said.
Diagnostic tests that make adjustments for race have gained the attention of Congress.
Last year U.S. Sens. Elizabeth Warren (D-Mass.), Ron Wyden (D-Ore.) and Cory Booker (D-N.J.) and Rep. Barbara Lee (D-Calif.) wrote a letter to the Agency for Healthcare Research and Quality asking for a review of race-based algorithms.