Race-Removed Kidney Test Boosts Transplants for Black Patients, Study Finds

A Shift in Kidney Transplant Criteria Increases Access for Black Patients

A recent study reveals a significant impact from the removal of race as a factor in calculating estimated glomerular filtration rate (eGFR), a key measure of kidney function. The change, implemented by the Organ Procurement and Transplantation Network (OPTN), has led to a notable increase in kidney transplant opportunities for Black patients, offering a tangible step toward addressing longstanding inequities in healthcare. Until 2021, eGFR calculations included a race-based adjustment that systematically underestimated kidney function in Black individuals, potentially delaying access to life-saving transplants.

For years, the standard eGFR calculation inflated results for Black patients by approximately 16% to 21%. This meant that some Black individuals were categorized as having better kidney function than they actually did, pushing them further down the transplant waiting list or disqualifying them altogether. The equation was phased out in 2022, and the OPTN mandated modifications for Black patients awaiting transplants. Now, data shows the policy shift is having a measurable effect.

The Impact of Race-Neutral eGFR Calculations

The study, published in JAMA Internal Medicine, found that the change impacted 27% of Black patients on the transplant waiting list, resulting in 5.3 more transplants per 1,000 Black candidates. “These tangible results are not only significant for nationwide efforts to ensure that kidney transplantation in the United States is fair and equitable for all those facing kidney failure, but they are deeply meaningful for the more than 21,000 people who have received wait time modifications since this policy was implemented,” stated LaVarne A. Burton, president and CEO of the American Kidney Fund.

Rohan Khazanchi, a health services researcher and resident physician at Boston Medical Center, and one of the study’s authors, explained that the research team was interested in examining “this type of reparative intervention that’s thinking about the people who were harmed by the fact that this race-based algorithm was in place, and trying to come up with a remedy that actually addresses some of that harm.” He emphasized that this represents “the first time that’s been done on a national scale.”

A Long-Fought Battle for Equity

The move to remove race from the eGFR calculation wasn’t swift or easy. It was, as Stat News reports, a “long process that divided the field of nephrology for years.” After a task force for the National Kidney Foundation voted to remove race from the eGFR, advocates for health equity hoped it would set a precedent for other areas of medicine. However, dozens of clinical algorithms still incorporate race as a variable.

Nephrologist Vanessa Grubbs, founder of the nonprofit Black Doc Village, who was not involved in the study, noted the resistance to change. “It was a really heated battle to gain the powers that be to have a race neutral equation. I was honestly surprised at how much people were fighting this. Some of the folks that were fighting it were saying things like, ‘It’s not going to resolve disparities in kidney disease’ and here we have some evidence of how it does mitigate some of the disparities.”

Debunking Concerns About Zero-Sum Outcomes

The study also addressed concerns that improving transplant rates for Black individuals might negatively impact transplant opportunities for other groups. Researchers compared transplant data before and after the policy implementation in 2023, analyzing data from over 180,000 candidates, including 56,000 Black individuals. Surprisingly, the study found no evidence that non-Black patients experienced lower odds of receiving a transplant.

An accompanying editorial in JAMA Internal Medicine suggested that the data “debunk[s] faulty zero-sum concerns that improving transplant rates for Black individuals could detract from transplant rates for other individuals.” Rohan Khazanchi cautioned that the increase in available kidneys in the years following the policy change may have contributed to this finding.

Remaining Disparities and Future Directions

While the OPTN policy appears to be having a positive effect, it doesn’t eliminate racial disparities in kidney transplantation. Research suggests the adjustments primarily benefited patients with consistent access to healthcare and those already on the waiting list. Wait time adjustments also varied depending on where Black candidates received care, highlighting regional differences in implementation and access.

Khazanchi emphasized the need for continued investigation into remaining inequities. “I think there’s more thinking to be done about what inequities we have addressed with this policy, and what inequities might be actually getting a little bit worse with a policy of this nature that inherently prioritizes people who had consistent access to care or had lab values in the last couple of years leading up to their transplant wait listing, versus those patients who just get really sick really fast and might have a different story that leads to their transplant wait listing.”

Khazanchi is also advocating for similar policy changes to address racial bias in lung function tests, which impact worker’s compensation payouts. He has been advocating for policies to remediate the effects of these tests.

Looking Ahead: Addressing Systemic Inequities

The success of removing race from the eGFR calculation offers a valuable lesson for the broader medical field. It demonstrates that actively addressing historical biases in clinical algorithms can lead to measurable improvements in health equity. However, it also underscores the importance of recognizing that a single policy change is unlikely to solve deeply rooted systemic problems. Continued research, coupled with a commitment to addressing social determinants of health and improving access to care for all populations, will be crucial to achieving true equity in kidney transplantation and beyond.