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Cited by 140Race, Genetics, and SocietyChronic Kidney Disease and DiabetesRacial and Ethnic Identity Research

Health inequities and the inappropriate use of race in nephrology

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Eneanya, Nwamaka D., Boulware, L. Ebony, Tsai, Jennifer, Bruce, Marino A., Ford, Chandra L., Harris, Christina, Morales, Leo S., Ryan, Michael J. +7 more·2022·Nature Reviews Nephrology
DOI 10.1038/s41581-021-00501-8PMC PMC8574929
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Abstract

Chronic kidney disease is an important clinical condition beset with racial and ethnic disparities that are associated with social inequities. Many medical schools and health centres across the USA have raised concerns about the use of race - a socio-political construct that mediates the effect of structural racism - as a fixed, measurable biological variable in the assessment of kidney disease. We discuss the role of race and racism in medicine and outline many of the concerns that have been raised by the medical and social justice communities regarding the use of race in estimated glomerular filtration rate equations, including its relationship with structural racism and racial inequities. Although race can be used to identify populations who experience racism and subsequent differential treatment, ignoring the biological and social heterogeneity within any racial group and inferring innate individual-level attributes is methodologically flawed. Therefore, although more accurate measures for estimating kidney function are under investigation, we support the use of biomarkers for determining estimated glomerular filtration rate without adjustments for race. Clinicians have a duty to recognize and elucidate the nuances of racism and its effects on health and disease. Otherwise, we risk perpetuating historical racist concepts in medicine that exacerbate health inequities and impact marginalized patient populations.

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  • Race corrections in clinical algorithms often have the effect of requiring patients of color to be sicker before they qualify for the same level of care as a White patient.

    “Such “corrections” are used in a variety of areas of medicine, from endocrinology and nephrology to oncology and obstetrics, which often have the effect of requiring patients of color to be sicker before they qualify for the same level of care as a White patient.24–26”

    From Challenging Race-Based Medicine Through Historical Education About the Social Construction of Race (2023) · cites this paper as [24]

    The section on racial disparities in kidney disease says the eGFR race coefficient can delay transplant waitlist priority for Black patients. The section on implications of race-adjusted equations also describes a heart-failure calculator that assigns Black patients lower mortality risk, potentially withholding recommended therapy. These examples support the claimed effect, but the paper does not establish that it occurs often across all the named specialties, particularly oncology and obstetrics. (LLM, conf=0.84)

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Authors
Eneanya, N. D., Boulware, L. E., Tsai, J., Bruce, M. A., Ford, C. L., Harris, C., Morales, L. S., Ryan, M. J., Reese, P. P., Thorpe, R. J., Morse, M., Walker, V., Arogundade, F. A., Lopes, A. A., & Norris, K. C.
Affiliations
  • University of Pennsylvania (US)
  • Duke University (US)
  • Yale University (US)
  • University of Houston (US)
  • University of California, Los Angeles (US)
  • University of Washington (US)
  • Johns Hopkins University (US)
  • Brigham and Women's Hospital (US)
  • The Ohio State University (US)
  • Obafemi Awolowo University (NG)
Corresponding author
Eneanya, Nwamaka D.
ORCID
Venue
Nature Reviews Nephrology
Publisher
Springer Science and Business Media LLC
Published
2021-11-08
Volume
18
Issue
2
Pages
84-94
ISSN
  • 1745-8323 (ISSN-L)
  • 1759-5061
  • 1759-507X
DOI
10.1038/s41581-021-00501-8
PMC
PMC8574929
OpenAlex
W3213752583
Cited by
140
References
182
Citations by year
2026: 17 · 2025: 23 · 2024: 37 · 2023: 28 · 2022: 33 · 2012: 1
FWCI
3.61
Type
journal article
Language
en
Open access
Licence
Locations
  • Nature Reviews Nephrology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • National Institutes of Health (2p60md000214-11, P30-AG02-1684, UL1TR001881)
  • National Institute on Aging (R01AG054363, K02AG059140, P30AG021684, P30AG059298)
  • National Heart, Lung, and Blood Institute (R25HL126145)
  • National Institute of Diabetes and Digestive and Kidney Diseases (K23DK114526)
  • National Center for Advancing Translational Sciences
  • National Institute on Minority Health and Health Disparities (U54MD000214, P60M.D.000214)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Race, Genetics, and Society
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
Keywords
health disparities, structural racism, racial disparities, chronic kidney disease, estimated glomerular filtration rate, biomarkers, Black patients, racial bias in medicine, renal function assessment, social determinants of health
MeSH terms
Health Inequities, Humans, Nephrology, Social Justice, United States, Health Status Disparities, Racism

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