Impact of Black Race coefficient in eGFR on Our Community and Medical Education

Abstract

A critical national conversation over the use of race in estimation of glomerular filtration rate (eGFR) was stimulated by medical students at the University of Washington over the past few years. They explored, with overdue scrutiny, the ways race is portrayed and used in medical education and practice. Questions were raised about the inclusion of the multiplicative factor for Black race in eGFR calculation, with implications for differential clinical management, and the possibility of disadvantaging patients, solely based on race. Their call for investigation and action, among the rising voices of many, started a reexamination of eGFR and the numerous other areas of medicine touched by racism. As a result, national groups of physicians, scientists, specialists, and patients (including the American Society of Nephrology and National Kidney Foundation) have called for removal of race from calculation of eGFR. We scrutinized use of Black race coefficient in eGFR calculation and consequence of its use on our local community in SW Michigan. A cross-sectional analysis of electronic health record (EHR) data from local hospital systems demonstrates the impact removal of race from eGFR calculation could have on our community. Our work may serve as a prototype for ongoing and thorough examination of questions of race in medicine. Truly eradicating racism from medicine may require continuous critical evaluation of current established norms of medical education and care. As similar issues arise in medical education, we can identify how such changes shape healthcare on a local level and integrate this knowledge into our education.  

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study did not receive any funding

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study underwent review and was approved by Western Michigan University Homer Stryker MD School of Medicine IRB (IRB#:WMed-2020-0661)

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.

Yes

Data Availability

All data produced in the present study are available upon reasonable request to the authors

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