Healthcare providers often make critical treatment and patient care decisions using algorithms, which are formulas designed to interpret a combination of data, such as test results, weight risks, and personal demographics, including sex and race. A 2020 study has revealed that a common medical formula may be preventing many Black chronic kidney disease (CKD) patients from receiving necessary care, like referrals to kidney specialists and kidney transplants.*

The problem

The formula in question is called CKD-EPI, the standard equation used to estimate the percentage of a person’s kidney function, or estimated glomerular filtration rate (eGFR). Lower scores indicate a smaller percentage of remaining kidney function and greater progression of the disease. With race factored in, Black patients’ scores are increased by 15.9%.

When researchers analyzed health records for 57,000 CKD patients in the Massachusetts General Brigham health system and recalculated their eGFR scores, they found that:

• Over 700 Black patients would have received a more severe disease status, requiring more urgent care, if the formula for White patients had been used.
• 64 of those would have been eligible for placement on a kidney transplant waitlist.
• None of those patients had been evaluated or referred for transplant surgery.

Mallika Mendu, an assistant professor at Harvard Medical School and kidney specialist at Brigham and Women’s Hospital called the results “staggering.” “We know there are already other disparities in access to care and management of the condition,” she said. “This is not helping.”

What’s being done

The CKD-EPI algorithm is just one of more than a dozen clinical tools that incorporate a patient’s race when formulating proposed treatments, including those for cancer and lung conditions. Fortunately, the issue is steadily gaining attention from both scientists and legislators. 

Representative Richard Neal (D-Massachusetts), is one of several lawmakers calling for a re-evaluation of all medical algorithms that factor in race. “Many clinical algorithms can result in delayed or inaccurate diagnoses for Black and Latinx patients,” he said, “leading to lower-quality care and worse health outcomes.”

A preliminary version of the findings led leaders at Massachusetts General Brigham to stop using the race-based eGFR formula earlier this year. Several other large U.S. medical centers have followed suit.

Vanessa Grubbs, associate professor at UC San Francisco, says that in addition to adjusting medical equations, healthcare providers should also re-evaluate how they:

• Review Black patients’ care plans  
• Train new doctors
• Think about race

Categorizing patients by race can affect access to, and quality of, care for people across many demographics, stated Grubbs.

*Simonite, T. (2020, Oct. 26). How an Algorithm Blocked Kidney Transplants to Black Patients. Wired. https://www.wired.com/story/how-algorithm-blocked-kidney-transplants-black-patients/