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1/ How might removing #race from #eGFR impact patient care? Our study in @JAMA_current quantifies the many implications for Black Americans: https://jamanetwork.com/journals/jama/fullarticle/2773808with @GloriaJWu @HermanATaylor @JKT0202 @Neil_R_Powe @ZakKohane @ArjunManrai
2/ Recent concern regarding the use of #race in #GFR estimation has prompted medical centers to reconsider these equations. Many are rightly concerned about issues of imprecision, non-transparency, and conflation of race with biology. https://jamanetwork.com/journals/jama/fullarticle/2735726
3/ Over the past year, institutions across New York, Boston, San Francisco, Seattle, Providence, Denver, and Nashville have removed #race from #eGFR, potentially impacting care for millions of Black patients.
4/ While there are several ways to reformulate #eGFR without #race, most decided to use the âIf White/Otherâ output for all patients. This option preserves accuracy for White patients but may lead to significant underestimation bias in Black patients. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2762876
5/ Because #eGFR is used for so many purposes, this bias may affect many elements of care.
These include: new diagnoses/reclassifications for CKD, contraindications/dosing for prescription drugs, and eligibility for specialist care, kidney transplantation, or kidney donation.
These include: new diagnoses/reclassifications for CKD, contraindications/dosing for prescription drugs, and eligibility for specialist care, kidney transplantation, or kidney donation.
6/ Our study evaluates the full range of these clinical implications in a nationally-representative cohort. We computed #eGFR +/- race for 9,522 Black patients in @CDCgov #NHANES and estimated how many would be recommended for changes in care by @goKDIGO and @MedicareGov.
7/ Potential benefits 
Enhanced access to nephrologist referrals (0.22% of Black adults) and kidney transplantation (0.051%), as well as Medicare coverage for CKD related services like medical nutrition therapy (0.49%) and kidney disease education (0.14%).
Enhanced access to nephrologist referrals (0.22% of Black adults) and kidney transplantation (0.051%), as well as Medicare coverage for CKD related services like medical nutrition therapy (0.49%) and kidney disease education (0.14%).
8/ Potential harms 
Exclusion of kidney donors (2.1% of Black adults) and new contraindications/dose reductions (0.29-1.2%) for ACEi, ARBs, BBs, metformin, SGLT2i, cisplatin, warfarin, and others. These drugs treat many conditions with sizable disparities for Black patients.
Exclusion of kidney donors (2.1% of Black adults) and new contraindications/dose reductions (0.29-1.2%) for ACEi, ARBs, BBs, metformin, SGLT2i, cisplatin, warfarin, and others. These drugs treat many conditions with sizable disparities for Black patients.
9/ Of course, #eGFR is not the end-all-be-all for these decisions. Local adaptation of eGFR-based guidelines, confirmatory testing, and clinical judgment may all lessen the expected effects.
https://www.acpjournals.org/doi/10.7326/M20-4951
https://www.acpjournals.org/doi/10.7326/M20-4951
10/ Lastly, potential benefits/harms must be interpreted within their full social and evidentiary context, including persistent disparities for Black patients, documented biases of eGFRcr without race, and the historical use of race as a biological construct to further racism.
11/ We hope our data can help hospitals understand and prepare for expected changes from removing race adjustment. Race-free equations are an important goal, and we should do everything we can to ensure that our chosen solutions donât worsen disparities. https://ja.ma/2CRe5NX
12/ For a more detailed coverage of this paper, check out the press release from @HarvardMed! https://www.eurekalert.org/pub_releases/2020-12/hms-rra120120.php
