Stereotypes, generalizations, and assumptions—all potentially hazardous—exist often because there is some detectable association between one thing and another. What isn’t always provable is that one thing exists because of the other.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), African-Americans are almost four times as likely as Whites to develop kidney failure. They account for 35 percent of people with kidney failure, all while making up merely 13 percent of the population. The leading causes of kidney failure in this community are Type II diabetes and high blood pressure. Some could speculate then that culturally preferred diets featuring excessive sodium and sugars create this problem in the Black community, thus this vulnerability to kidney failure is inevitable. But what if there is another factor?
Professor of Medicine and Executive Vice Chair for Equity, Diversity and Inclusion at the UCLA Department of Medicine Dr. Keith Norris knows that there is. He is one of a number of nephrologists who have been advocating for a change in the problematic formula used to assess how well the kidneys function (known as eGFR) for several years now.
“We used to add 16% to your eGFR if you were Black/African American,” Dr. Norris explained.
This equation adjustment engineered by a team of doctors at Tufts University in 2009 was based on the premise that African-Americans have greater muscle mass than White Americans. A person with more muscle mass will have a higher level of creatinine, a chemical the body produces continuously that is filtered out by the kidneys. The understanding was that if Black people are always going to have more creatinine in their blood, seeing a larger amount of it that isn’t being filtered out by their kidneys shouldn’t be as alarming.
“The medical community had accepted the premise that the programming to create the formula was valid,” Dr. Norris explained. “Given the very clear disparities by race and ethnicity in the need for dialysis and transplantation, the fact that there was a difference in the GFR formula by race did not seem unusual. However, on closer inspection the way race and ethnicity can and should be used in formulas to help us understand when and where there may be disparities is limited. The students [who initially raised this issue in medical school] were correct in that the racial or ethnic group level differences cannot be assigned equally to each member of a group because race and ethnicity are in fact what we call social constructs and are also what we call latent variables.”
As of this year, the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Diseases are urging laboratories nationwide to adopt a newly modified equation that will diagnose chronic kidney disease earlier and help save lives.
“The old formula gave a higher number to a Black/African-American person than the present formula does,” Dr. Norris explained. “The old higher number could potentially lead to a delay in action for addressing early kidney disease. With the new race-free formula, this should no longer be the case.”
A Howard University Medical School graduate who has lived out his grandfather’s dream of becoming a doctor, Dr. Norris, along with his colleague, Dr. Susanne Nicholas of UCLA, directly participated as an interviewee in part of the process by the NKF and the ASN to review and ultimately remove race from the eGFR formula. Dr. Norris applauds the move but also appreciates the challenges that remain.
“Part of the fallout has been the medical community not wanting to say it was wrong, and many still believing that race and ethnicity are in part biologic in nature and therefore can be used at an individual level,” he said. “Much of this is due to the fact that there are very strong associations between race and ethnicity and many biologic and clinical conditions. However, these are merely associations, and these are not innate properties of race or ethnicity. But many people still believe they are. That belief is incorrect.”
These differences don’t discourage Dr. Norris, who continues to be a critical voice for minorities as it relates to kidney health. He participated in the study that helped to identify which type of blood pressure medicine was most effective for African-Americans with high blood pressure and CKD, and he has also been an advocate for minorities in the field of medicine in general. “I’m proud of being able to help train and promote thousands of young minority students to enter the field of biomedical sciences,” he said.
Apparently, this is sorely needed. More minority medical students, less muscle mass hysteria.
Learn more about the new race-free eGFR formula that can save lives through early detection of kidney disease at www.kidney.org.
