Algorithmic Changes Are Not Enough: Evaluating the Removal of Race Adjustment from the eGFR Equation
CoRR(2024)
Abstract
Changing clinical algorithms to remove race adjustment has been proposed and
implemented for multiple health conditions. Removing race adjustment from
estimated glomerular filtration rate (eGFR) equations may reduce disparities in
chronic kidney disease (CKD), but has not been studied in clinical practice
after implementation. Here, we assessed whether implementing an eGFR equation
(CKD-EPI 2021) without adjustment for Black or African American race modified
quarterly rates of nephrology referrals and visits within a single healthcare
system, Stanford Health Care (SHC). Our cohort study analyzed 547,194 adult
patients aged 21 and older who had at least one recorded serum creatinine or
serum cystatin C between January 1, 2019 and September 1, 2023. During the
study period, implementation of CKD-EPI 2021 did not modify rates of quarterly
nephrology referrals in those documented as Black or African American or in the
overall cohort. After adjusting for capacity at SHC nephrology clinics,
estimated rates of nephrology referrals and visits with CKD-EPI 2021 were 34
(95
African American. If race adjustment had not been removed, estimated rates were
nearly identical: 38 (95
Changes to the eGFR equation are likely insufficient to achieve health equity
in CKD care decision-making as many other structural inequities remain.
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