Elimination of race in estimates of kidney function to provide unbiased clinical management in Canada – CMAJ – DC Initiative on Racial Equity
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Commentary

Rulan S. Parekh, Jeffrey Perl, Bourne Auguste and Manish M. Sood

CMAJ March 21, 2022 194 (11) E421-E423; DOI: https://doi.org/10.1503/cmaj.210838

KEY POINTS

  • For many years, the universally used Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) for estimating kidney disease function has included an adjustment for Black race that resulted in an upward correction in estimated glomerular filtration rate (eGFR).

  • In 2021, new equations that omit race but include other factors were developed and found to be more accurate in estimating eGFR.

  • In Canada, Black people are at elevated risk of developing kidney disease, have more rapid progression of kidney disease, are referred later for kidney care, are less likely to receive home-based dialysis or a kidney transplant, and have higher mortality after kidney transplantation.

  • Widespread implementation in clinical practice of new equations for eGFR that omit a correction for race would be an important first step toward equitable delivery of kidney care for Black people in Canada.

For many years, the universally used equation for estimating risk of kidney disease (the kidney function estimate, Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] equation), included an adjustment for Black race that led to an upward correction in estimated glomerular filtration rate (eGFR). In 2021, new equations that omit race but include other factors were developed and found to be more accurate in estimating eGFR,1 and the US National Kidney Foundation, American Society of Nephrology Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Diseases and the UK National Institute for Health and Care Excellence recommended the removal of race from the calculation of eGFR.2,3 We discuss why the inclusion of race in kidney function estimates is biased and harmful, and why swift adoption of calculations that omit race is important in clinical care in Canada.

In the United States and Canada, Black people have a higher incidence of chronic kidn


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