A ‘Raceless’ Approach to Diagnosing Kidney Disease


A scientific task force on Thursday called for the discarding of a common measure of kidney function that adjusts results by race and provides different assessments for Black patients than others.

According to many experts, the edit may make black patients look less sick than they really are. A report from the National Kidney Foundation and the American Society of Nephrology concluded that instead, doctors should rely on a race-neutral method to diagnose and manage kidney disease.

Suggested custom equation It was described in a study published Thursday in the New England Journal of Medicine..

If the new approach is adopted, it will affect the hundreds of millions of kidney function tests performed each year in hospitals and outpatient settings, both for acutely ill patients and as part of routine screening blood tests. By one estimate, one million Black Americans could be treated for kidney disease sooner if the diagnostic equation is not adjusted for race.

Concurrently published task force report, American Journal of Kidney Diseases and Journal of the American Society of Nephrologycomes amid a national showdown over racial health disparities spurred by the Covid-19 pandemic, which has disproportionately damaged people of color and highlighted the extreme chronic disease burdens in these communities.

Zuckerberg, co-head of the task force and head of medicine at San Francisco General Hospital and Trauma Center, Dr. “The problem is a moral one,” said Neil R. Powe. “It’s time to take racing out of the equation.”

Black and Hispanic Americans have long suffered from high rates of ailments such as diabetes, high blood pressure and obesity that can exacerbate a Covid-19 episode. These factors can also increase the risk of developing kidney disease.

Racial differences in kidney disease are sharp and well documented. Black Americans are three times more likely than white Americans to experience kidney failure and require dialysis or a kidney transplant.

Although black Americans make up only 13 percent of the population, represents 35 percent more than 90,000 Americans with kidney failure are on the waiting list for kidneys; almost a third black, as many as the white ones.

People of color and low-income Americans less likely to receive good care And chronic kidney disease can be prevented when warning signs first appear. They are more likely to progress to kidney failure and need dialysis, and less likely to be cared for by a kidney specialist before they reach this stage, according to a report by the Centers for Medicare and Medicaid Services.

Black Americans too waiting longer for an organ, and they are less likely to have a kidney donated by a friend or relative for various complicated reasons.

Nephrologist Dr. “This new recommendation will ensure that racial bias is not included in clinical care, so one will no longer be judged by their race and allow skin color to dictate which kidney care they receive,” said Nwamaka Denise Eneanya. University of Pennsylvania and a member of the task force.

Their study suggests that current measures used to assess kidney function may underestimate the severity of the disease in Black patients, delay referral to specialists, and make them less likely to be placed on waiting lists for kidney transplants.

Dr. “Black individuals are unintentionally harmed because they are not sick enough,” Eneanya said.

Other task force members warned that the impact of the change on patient outcomes was uncertain and urged researchers to follow up to assess its impact.

The use of medical decision-making tools that consider race and ethnicity is not specific to kidney disease. Algorithms and calculators that doctors rely on to guide diagnosis and treatment for many conditions, from bone density and kidney stones to cancer and pulmonary function tests, include race as a variable. outlined in a paper It was published last year in the New England Journal of Medicine.

Vice President of the kidney division at Massachusetts General Hospital in Boston, Dr. “Race is a social construct, not a biological construct,” said Winfred Williams. an editorial on new equations.

“It can act as a proxy for other risk factors that can limit access to best health practices, such as food insecurity, housing insecurity, socioeconomic deprivation.”

In recent months, several medical communities have taken steps to address potential bias. American Academy of Pediatrics in May officially dropped Practice guide that considers the baby’s breed when assessing the risk of urinary tract infection.

The American College of Obstetricians and Gynecologists is currently updating an algorithm that includes race and ethnicity in a calculator used to evaluate a pregnant woman’s chances of having a successful vaginal delivery after a previous cesarean section.

The new report, which reassesses the inclusion of race in the diagnosis of kidney diseases, was released Thursday after a year of study and a little discussion along the way, the authors said.

The kidneys filter toxins from the blood. The new report proposes using a new equation to estimate filtration rate using a blood test that measures levels of creatinine, a waste product produced by muscles that are kept in check when the kidneys are working properly.

A related study, published Thursday in the New England Journal of Medicine and cited in the report, developed and evaluated new diagnostic methods that did not include race as a variable. The researchers concluded that the new creatinine equation could be adopted immediately.

But the most accurate, race-neutral way to measure kidney filtration rates would involve blood tests that measure the level of a different marker: a protein produced by cells called cystatin C, which is elevated when the kidneys aren’t working well, the researchers said.

Cystatin C tests are more expensive and not widely available, but experts have called for making them more accessible and gradually increasing their use.



Source link

Leave a Reply

Your email address will not be published. Required fields are marked *