Under a new race-neutral assessment, thousands of African Americans living with chronic kidney disease could gain access to specialty treatment or transplantation for the first time.
University of Maryland Medicine, composed of the University of Maryland Medical System (UMMS) and the University of Maryland School of Medicine (UMSOM), has announced that it will end the use of a longstanding clinical standard that factors a patient’s race into the diagnosis of chronic kidney disease. The change could increase access to specialty care, including eligibility for kidney transplantation for thousands of Black people living with advanced kidney disease.
By late January, the system, including its flagship academic hospital, the University of Maryland Medical Center, will transition to a new standard of evaluating kidney function, eliminating whether a patient is “African American or non-African American” as a factor. The move follows a review by UMSOM clinicians and scientists of recently released recommendations from professional societies.
“We assembled an interdisciplinary ad hoc group of faculty at the University of Maryland School of Medicine many months ago to begin discussing a plan to replace race-based eGFR [estimate glomerular filtration rate] to assess kidney function,” said Sandra Quezada, MD, MS, AGAF, UMSOM associate dean for admissions, assistant dean for faculty diversity and inclusion, and associate professor of medicine in the Division of Gastroenterology and Hepatology. “National guidelines were published in late September with recommendations on alternative equations to use, and we were able to present this to our University of Maryland Medical System leadership, which has responded positively and swiftly. We are so proud that the system is implementing this important change for the benefit of our patients.”
By one estimate, approximately 720,000 African Americans might be treated earlier for kidney disease if race were removed from the calculations of kidney function. In Maryland, and the Mid-Atlantic region more broadly, thousands of people could be impacted by this transition to race-free eGFR.
“This is a significant development for University of Maryland Medicine and for academic medicine in general,” said Mohan Suntha, MD, MBA, president and CEO of UMMS. “We are in a period of evolution toward truly understanding the scope and impact of race-based disparities in health care and taking steps to address inequities. I commend our physician leadership and University of Maryland School of Medicine partners who have taken swift and decisive action to operationalize this change across our system hospitals, programs, and clinical partners. We are proud to be among the nation’s first academic medical systems leading this imperative.”
Since 1999, nephrologists across the country have used an equation to estimate glomerular filtration rate (eGFR), which reflects how well a person’s kidneys filter waste. This equation relies on levels of creatinine — a byproduct of muscle and protein metabolism — from the blood. In addition to age and gender, the calculation takes into account whether a patient is “African American or non-African American” and assigns a multiplier based in part on a discredited notion that Black people tend to have more muscle mass than people of other races. This higher value often overestimates the health of Black patients’ kidneys, pushing them above the threshold for diagnosis of advanced kidney disease and, therefore, leading to delayed referral for specialty care, or even disqualification for kidney transplant.
Following a report last year in the The New England Journal of Medicine, the National Kidney Foundation and the American Society of Nephrology formed a joint task force to review the use of race in eGFR calculations. In September, the group endorsed a new calculation without the race coefficient. A committee of UM Medicine researchers, kidney specialists, clinical quality leaders, and health equity champions — including Quezada and others — quickly convened to closely review the new guidance and drive forth a strong recommendation for change. This change also was enthusiastically endorsed by the Quality and Safety Committee of the UMMS Board.