Clinical

UW medical students initiate one of the first of its kind transition to the calculation of estimated glomerular filtration rate that is not adjusted by race.

A serum creatinine test measures the level of creatinine in your blood and provides an estimate of how well your kidneys filter (glomerular filtration rate).

When measuring kidney function, virtually every laboratory in the United States, including UW Medicine, automatically calculates an estimated glomerular filtration rate (eGFR) every time serum creatinine is measured. This test has traditionally used the Modification of Diet in Renal Disease (MDRD) equation to calculate eGFR to determine levels of creatinine in each sample.

The eGFR results are then reported with race factored as a precision variable. The usual approach is to report two values – one for Blacks and another for non-Blacks.

In 2018, the conversation was initiated by UW School of Medicine medical students questioning the strength of evidence underlying the reporting of eGFR by race.

Naomi Nkinsi
Naomi Nkinsi

“So how did we make this change? We made it by questioning lecturers when the MDRD was taught. We did it by not letting the issue go and continuing to push discussions in class about the use of this equation…

We did it by having meetings with teaching faculty, sending articles to them like the one in JAMA, forcing discussions in small group sessions, and making use of the advocacy framework that we built via ARAC.”

– UW School of Medicine MD/MPH Student, Naomi Nkinsi via Twitter

In addition to a lack of rational for using a race coefficient, the MDRD equation can underestimate GFR in many individuals and be unreliable in informing clinical actions. Advocacy by students and the UWSOM Anti-Racism Action Committee  led to iterative assessments of approaches for  eGFR testing across the UW Medicine community, including faculty from the Departments of Family Medicine and Laboratory Medicine, and the Division of Nephrology in the Department of Medicine.

This interdisciplinary team determined that the use of race in the biomedical environment is an imprecise variable and does not meet the scientific rigor UW Medicine expects of diagnostic tools.

As of June 1, 2020, laboratories at UW Medicine will transition from the use of MDRD equation to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation in the calculation of eGFR. The new protocol excludes race as a variable. Instead, CKD-EPI results are based on serum creatinine, age, and sex and is normalized to 1.73 m² body surface area.

Dr. Rajnish Mehrotra
Dr. Rajnish Mehrotra

“This is a momentous change where UW Medicine is leading the way,” said Dr. Rajnish Mehrotra, interim head of the Division of Nephrology.

This recent shift in diagnostic protocol further demonstrates the need for medical professionals and medical centers to question the appropriateness of racial attributions in medicine and emphasizes the teaching and practice of medical advancements that do away with using race as a proxy, indicator, or adjustor.

“The historic decision by UW Medicine to no longer use race as a variable to estimate kidney function is significant in multiple ways," says Nkinsi. "First, it shows that our medical system refuses to participate in the perpetuation of racism in medical practice, and has taken a stand to end the false narrative that Black bodies are inherently inferior to White bodies.

Secondly, the move signals that medical students have a powerful voice that is already shaping the future of academic medicine. This was an effort led by medical students, especially Black students, who have advocated to remove racism in the medical school curriculum and in clinical practice for many years.

This decision shows that students can have a profound impact. It is because students persisted in asking questions and having sometimes difficult conversations that an institution, and the field of medicine more broadly, changed.”