For Black patients, nixing ‘race adjustment’ may improve kidney transplant odds, study finds: Study shows race-free creatinine formula helps equalize access
Using equations to calculate kidney function that do not include race adjustments would result in Black patients gaining time on the transplant waitlist before their kidneys fail that matched similar durations for white patients, according to a new study led by UC San Francisco and Hennepin County Medical Center in Minneapolis.
In their study, publishing in the journal CJASN on Sept. 19, 2022, the researchers compared the length of time from waitlist eligibility to kidney failure for Black and white patients.
“The earlier a patient is waitlisted prior to kidney failure, the higher priority the patient has in getting a transplant and the more likely a patient could potentially avoid dialysis,” said first author Elaine Ku, MD, of the UCSF Division of Nephrology and of the Department of Epidemiology and Biostatistics. “Patients who avoid dialysis, or do it for a short period, generally have better outcomes than those on dialysis in the long term,” she said.
Kidney transplant waitlist eligibility is determined by a formula that calculates estimated glomerular filtration rate (eGFR). It measures creatinine, a breakdown product of muscle tissues, and factors in a patient’s age and sex. Previously, the equations for eGFR had a race adjustment that meant Black patients had a higher eGFR despite having the same creatinine level. The rationale for this is based on earlier studies that show Black people may have naturally higher levels of creatinine.
Recognizing Race as Social Construct Prompts Criteria Review
However, in recognition of race as a social construct, rather than a biological one, the American Society of Nephrology and the National Kidney Foundation last year recommended the removal of these race modifiers, which adjust kidney function upward by 16% in Blacks. The current transplant waitlist requirement for patients regardless of race is eGFR 20 ml/min, significantly lower than 90 ml/min or higher, which is considered normal.
Source: Read Full Article