Removing Race From eGFR
A crowdsourced toolkit
Racism, not race, causes health disparities. Using race in the eGFR calculation perpetuates flawed science and fails to address the root case - racism.
This toolkit is a live repository of the tools that activists, trainees, faculty, lab directors and more around the U.S. have contributed to building in their efforts to remove race-based eGFR reporting at their institutions. Many thanks to those whose tireless efforts are shifting the needle.
Clinical Updates to eGFR
In 2021, the National Kidney Foundation and American Society of Nephrology recommended an update to the CKD-EPI equation for estimating eGFR that does not use a racial correction factor. We are now in the phase of working to ensure all institutions nationwide make the switch and to use this moment to leverage further action on structural racism and health inequities through kidney medicine and the healthcare system!
A tool for change
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For the Community
This graphic is designed to help all community members understand why this change was made and how it affects their care. We hope to spark further advocacy with community members and ask that this knowledge be shared widely!
Full alt-text for screen readers can be found at https://tinyurl.com/2mvda7fk or at the download below.
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For Clinicians
With a little extra detail, we intend this graphic to serve clinicians and providers everywhere in understanding and implementing the new CKD-Epi equation in their practices and labs.
Full alt-text for screen readers can be found at https://tinyurl.com/mp5xkb2a or at the download below.
Please share these tools widely so that all can learn and shape a more equitable health system!
Don’t forget to download and link to the alt-text as you share!
We also ask that you please credit IHJM as you share. If you have feedback for us regarding this graphic or other aspects, please us the feedback form on the bottom of the page.
What’s next for you? Scroll below for more resources including the evidence base for these changes, sample email templates to collaborate with colleagues for change, and more.
Don’t know where to start? Start here and stay tuned for a national petition as well as a way to connect with others doing this work!
What’s the evidence base?
Need some more citations or help with your language to make the case for removing race from eGFR? These resources have been used in advocacy at various institutions.
The research basis for the new equation can be found here:
Inker, et al (2021) - “New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race”
Delgado, et al (2021) - “A Unifying Approach for GFR Estimation: Recommendations of the NKF-ASN Task Force”
IHJM report - Section 3.2: Kidney Disease and Race
“The Case Against Race Correction in eGFR” (written by a team of med students at U of A)
Eneaya, Yang, and Reese (2019) - “Reconsidering the Consequences of Using Race to Estimate Kidney Function”
Vyas, Eisenstein and Jones (2020) - “Hidden in Plain Sight: Reconsidering the Use of Race Correction in Clinical Algorithms”
A podcast from Vanderbilt University Medical Center.
How can I talk to my colleagues?
Institutions and individuals have shared templates of letters and petitions used to build their base and grow support for removing race from eGFR algorithms.
A collection of emails, memos, and other resources compiled by the team at SF General Hospital (part of the UCSF system
Our eGFR Working Group has submitted several policy papers to key federal groups, including a Request for Information (RFI) to the Ways and Means Committee and an RFI to the federal Agency for Healthcare Research & Quality.
How can we push this further?
We now have a chance to use the implementation of the new eGFR equations to further address structural racism and health inequities throughout nephrology, primary care, laboratory medicine and much more. How can you spark a change at your institution?
Although a few of these opportunities are now out of date, we encourage you to adapt petitions, white papers and other resources to the institution you’re working with!
Interested in policy-level action? Check out these two:
A policy advocacy letter written to the CMO of the National Kidney Foundation from medical students
A policy resolution calling on the AMA to denounce racial essentialism
Who are some allies I can connect with?
Sign up to join our eGFR and/ or ASCVD working groups here!
In addition, check out these press releases and articles!
A New York Times article highlighting some of the evidence base and changes in different institutions, as well as some of the pushback.