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A race-specific algorithm designed to assess kidney function for individuals awaiting transplants jeopardized critical treatment for some Black Americans.

An exclusive report by the Associated Press released April 1, revealed over 14,000 Black kidney transplant candidates were granted expedited placement on the waiting list for kidney transplants after health officials identified that the test utilized to assess the health of their kidneys yielded inaccurate results. 

According to the report, the commonly used test, known as estimated glomerular filtration rate (eGFR), inaccurately recorded the kidney function of Black individuals, portraying them as healthier than their actual condition. This significant flaw originated from an automated formula that employed separate calculations for Black and non-Black patients.

Health officials worried that the race-based equation may have postponed the diagnosis of organ failure and critical transplant evaluation care for thousands of Black candidates, who were placed lower on the transplant waitlist due to the error.

“Health equity scholars have been raising alarm bells about the way race has been misused in clinical algorithms for decades,” Dr. Michelle Morse, New York City’s chief medical officer, told the Associated Press.

“Lots of time when we see health inequities, we just assume there’s nothing we can do about it,” Morse added. “We can make changes to restore faith in the health system and to actually address the unfair and avoidable outcomes that Black people and other people of color face.”

According to the National Kidney Foundation, African Americans are three times more likely to experience kidney failure than white individuals. This is due in part to higher rates of diabetes and high blood pressure within the community. 

Structural flaws within the healthcare system are also to blame.

In a 2020 study spearheaded by University of Washington professor Yue Harn Ng, findings revealed that Black patients faced a 25% lower likelihood of being waitlisted for a kidney transplant, even after physicians evaluated their medical factors and social determinants of health.

The eGFR test has long been relied upon by doctors as a largely accurate measure of kidney function and has been used to determine waitlist eligibility. It assesses the level of creatinine in your blood, a waste product from muscle activity, according to the American Kidney Fund. 

Healthy kidneys effectively remove creatinine from the blood, expelling it through urine. However, if kidney function is compromised, creatinine levels will rise in the bloodstream. The eGFR test provides a numerical value of the concentration of creatinine in a kidney patient’s bloodstream, but the test is reportedly flawed and has been known to overestimate a Black patient’s kidney function by up to 16%, the Mayo Clinic noted.

Faulty test results delayed critical care for Jazmin Evans, a patient, who disclosed that she had been awaiting a new kidney for four years until her hospital informed her of an error with her eGFR test. Doctors revealed that she should have been placed on the kidney transplant waitlist in 2015 instead of 2019.

“I remember just reading that letter over and over again,” Evans said. “How could this happen?”

In 2021, a task force, spearheaded by the National Kidney Foundation and the American Society of Nephrology (ASN), unveiled recommendations to eliminate race as a determining factor in the eGFR calculation.

A year later, the United Network for Organ Sharing (UNOS), the organization that oversees the transplant medical system, announced that hospitals were required to use “race-neutral eGFR formulas” for testing.

To compensate for the delayed care, UNOS adjusted the wait time for over 14,300 Black kidney transplant candidates from January 2023 to mid-March. To date, more than 2,800 of them, including Evans, have received a transplant.

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