Resolving the Debate: The Future of Using Race in Estimating Kidney Function

  • Cynthia Delgado
    Address correspondence to Cynthia Delgado, MD, San Francisco Veterans Affairs Healthcare System, 4150 Clement Street, Box 111J, San Francisco, CA 94121.
    Nephrology Section, San Francisco VA Medical Center, San Francisco, CA

    Department of Medicine, University of California, San Francisco, San Francisco, CA
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  • Neil R. Powe
    Department of Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, San Francisco, CA

    Department of Medicine, University of California, San Francisco, San Francisco, CA
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      Racial and social unrest witnessed during 2020 ignited a national conversation about the appropriateness of the use of race in health care algorithms and in the estimation of kidney function in particular. The growing concerns over the use of race in kidney function–estimating equations prompted the National Kidney Foundation (NKF) and American Society of Nephrology to launch an effort for change by establishing a task force on reassessing the use of race in diagnosing kidney disease. After nearly a year examining the evidence and obtaining testimony from experts and stakeholders, the task force recommended the immediate implementation of the 2020 Chronic Kidney Disease-Epidemiology creatinine equation refit without race in all US laboratories; increased routine use of cystatin C for confirmation of estimated glomerular filtration rate in clinical decision-making and a call for research on glomerular filtration rate estimation with new endogenous filtration markers and on addressing disparities in health and health care. The NKF and American Society of Nephrology strongly encouraged rapid adoption of these new recommendations. Leadership efforts of the NKF have begun to lay the foundation for national implementation through laboratory engagement, clinician awareness, and patient education.

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