M Health Fairview won't use race as a factor of kidney health
M Health Fairview will no longer use race as a determinant of kidney health, a practice that could make Black people's kidneys seem healthier than they may really be.
The Minneapolis-based health care system made this announcement in a news release Tuesday, noting it comes following recommendations from a task force of physicians that convened in June 2020.
Healthcare providers across the U.S. for decades have automatically adjusted the estimated glomerular filtration rate (eGFR) — a measurement of kidney health — based on a person's race, with Black people having one set of guidelines and non-Black people having another.
M Health Fairview says "based on the incorrect assumption that race is biological" (race is a social construct — there is no common set of genes between all Black people or all white people, so race is not a biological attribute) this adjustment can make Black people's kidneys seem healthier than they are, which can lead to delays in getting advanced care and/or being listed for a kidney transplant.
Here Stat News explains why the eGFR test has come under scrutiny:
"The test — which measures what’s known as estimated glomerular filtration rate, or eGFR — has historically considered four factors: age, gender, race, and levels of creatinine — the waste that kidneys filter out of blood. But the race of a patient can only be bucketed into two groups: Black, or not Black. That’s based on a flawed assumption that dates back to the formula’s creation, when medical experts presumed that Black people have higher muscle mass on average, leading to higher kidney function."
What this means is that Black people automatically have points added to their score for kidney function, making them less likely to qualify for a kidney transplant compared to non-Black patients.
"When we evaluated the effect of this practice on patient care, we found it at best, problematic,” said M Health Fairview Hospitalist Kristina Krohn, MD., who chaired the task force. “As we find a better way, we need to stop doing what we know is causing harm.”
Healthcare providers across the U.S. are reevaluating calculations like this, which is being driven by scientists, providers, medical students and the racial justice movement, M Health Fairview said.
“Medicine has to reckon with its role in the process of justifying exploitation and oppression,” said M Health Fairview Internist Brooke Cunningham, MD, PhD, who was also a member of the task force. “We need to interrupt that legacy, and one way to do that is by interrogating the ideas grounding these calculators and algorithms. If the origin of the calculator is based on a biological construction of race, we need to change it.”
The healthcare system will stop using the race-based eGFR adjustment in July.
M Health Fairview says removing the automatic adjustment is one example of its work to eliminate structural racism in healthcare, stemming from the creation of its Healing Opportunity, People and Equity (HOPE) Commission last summer.
Internist and pediatrician Taj Mustapha, who was on the eGFR task force and is on the HOPE Commission said the healthcare system is taking a "critical look" at how it operates.
“Reckoning with the inequities and flawed constructs that are embedded within healthcare and medicine will take time and work, and this is just one example of such work that is happening across the enterprise," Mustapha said.
M Health Fairview is a collaboration between the University of Minnesota, University of Minnesota Physicians and Fairview Health Services. It has 10 hospitals and 60 clinics.
