A new formula can help black patients get kidney care

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For decades, doctors Hospitals’ views on patients with kidney disease vary from race to race. The standard equation for estimating kidney function has been revised for black patients to make their health look more optimistic. Prevent access to transplants and other treatments.

On Thursday, a working group composed of two leading kidney care associations stated that this practice is unfair and should be ended.

The team is a collaboration between the National Kidney Foundation and the American Academy of Nephrology, and recommends the use of a new formula that does not consider the patient’s race. In a statement, the chairman of the foundation Paul Palevsky urged “all laboratories and healthcare systems across the country to adopt this new method as soon as possible.” This call is significant because the recommendations and guidelines of professional medical associations are shaping Experts play an important role in how to care for patients.

A study Published in 2020 A review of the records of 57,000 people in Massachusetts found that if the same version of the formula as white patients was used for evaluation, one-third of black patients’ disease would be classified as a more serious disease. Traditional kidney computing is an example of a class of medical algorithms and calculators that have recently come under fire for adjusting patient care based on race, which is a social category rather than a biological category.

review Published last year More than a dozen such tools are listed in fields such as cardiology and cancer care. It has helped promote activism against this practice from different groups, including medical students and legislators such as Senator Elizabeth Warren (Massachusetts) and House Ways and Means Committee Chairman Richard Neal (Massachusetts).

Neil writes to Medical Association with Center for Medicare and Medicaid Services They were asked last year to investigate the impact of clinical algorithms using race. He welcomed the news from the Nephrology Working Group on Thursday and told Wired magazine, “I hope others will follow them, and we will work together to build a fairer health system for all.”

There are recent signs that the trend is changing. After student protests led to reconsideration of the practice, the University of Washington abandoned the use of race in kidney calculations last year. Mass General Brigham and Vanderbilt Hospitals also abandoned this practice in 2020.

In May, a tool for predicting the chances of a safe vaginal delivery for women who had previously had a cesarean section was updated, and black and Hispanic women are no longer automatically assigned low scores. A calculator for calculating the probability of a child’s urinary tract infection has been updated, and the scores of black patients are no longer reduced.

The previous formula used to assess kidney disease, called CKD-EPI, was introduced in 2009 and updated the 1999 formula that used race in a similar way. It converts the level of a waste product called creatinine in the human blood into a measure of overall kidney function, called the estimated glomerular filtration rate or eGFR. Doctors use eGFR to help classify a person’s disease severity and determine whether they are eligible for various treatments, including transplants. Healthy kidneys will produce higher scores.

The design of the equation takes into account a person’s age and gender, but also increases the score of any patient classified as black by 15.9%. This feature is included to explain the statistical patterns seen in the patient data used to inform the CKD-EPI design, which includes a relatively small number of blacks or other ethnic minorities. But this means that the race a person perceives may change their disease measurement or treatment. For example, a person with both black and white ancestry can change the health system’s classification of their disease based on how doctors think about them or how they recognize them.

Nwamaka Eneanya, an assistant professor at the University of Pennsylvania and a member of the working group who made recommendations on Thursday, said she knew a mixed-race patient with severe kidney disease. After understanding how the equation works, she asked to classify her as white To increase her chances of being classified as senior care. Eneanya said that the established equation should have been changed long ago. “It is completely wrong to use someone’s skin color to guide their clinical path-when you do this, you introduce racial bias in healthcare,” she said.

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