Rethinking Race, Kidney Function

Study forecasts advantages, disadvantages for Black patients

kidney function stock photo
Image: saengsuriya13/iStock

Race is not biology. As a social construct, race is an unreliable predictor of physiologic variation and a notoriously unreliable marker for biologic differences across populations.

To reflect this growing realization, hospital systems and professional medical organizations have started reconsidering the use of race in clinical calculators that estimate how well a person’s kidneys work. Indeed, some hospital systems have already removed race from these commonly used clinical tools.

But what this move might mean for patients remains unclear.

Now a new study from Harvard Medical School forecasts the effects of this change if implemented nationwide. The results, published Dec. 2 in JAMA, suggest that removing race from kidney function tests might have both advantages and disadvantages for Black people with kidney disease.

The analysis represents the most comprehensive study to date to assess the impact of eliminating race from kidney function formulas. It is intended to help clinicians, healthcare organizations and policymakers understand the implications of such a decision, allocate resources, monitor patients and individualize care. The findings should also help patients understand what the change may mean for them and lead to greater involvement in their own care.

The researchers say that the current way of calculating kidney function by adjusting for race is flawed. However, they also caution any changes must be implemented with full understanding of the possible effects.

“The remnants of race-based medicine well into the 21st century expose a historical legacy of crude approaches to using identity in clinical practice,” said study senior investigator Arjun Manrai, an assistant professor of biomedical informatics in the Blavatnik Institute at Harvard Medical School.

“We must find better ways to individualize care and removing race from clinical algorithms is an important goal. But we must ensure that in doing so we do not inadvertently harm the very individuals we are trying to protect and care for,” Manrai said.

Read full article in HMS News