NEW in EPIC: Race-Neutral Diagnostic Formula for Kidney

3 top clinical questions answered

Whether due to race, ethnicity, gender or low socioeconomic status, health inequity is a complex issue that requires careful investigation and novel solutions. In 2020, when Ochsner Health announced the Healthy State by 2030 initiative, chronic kidney disease (CKD) was identified as a focus area in order to improve Louisiana’s high rate of people living with multiple chronic conditions. Delivering on that commitment, Ochsner Health and Ochsner Health Network removed race from CKD calculations beginning August 1, 2022, a move that will ultimately lead to earlier detection and treatment of CKD in our communities. One in seven Americans suffer from CKD. Practicing physicians in the deep South – whether in primary, specialty, or emergency care – see patients pervasively with both obvious and not-so-obvious risks. And yet a staggering forty percent of the at-risk population remain unaware of their condition. (CDC.gov/kidneydisease)

Black/African American patients experience higher risk for developing kidney disease, especially among older age groups. Furthermore, factoring race, technically a social construct and not a biological one, has been shown to skew accuracy of CKD diagnosis… the standard eGFR (estimated Glomerular Filtration Rate) overestimates kidney function among African Americans, and, in turn, studies have shown impediments to diagnosis, delays in treatment and transplantation, and poor outcomes.

“Removing race from the clinical formula to evaluate kidney function marks another stride in Ochsner’s quest to improve healthcare access for all, with inclusivity at the heart of our mission,” commented Ochsner Health Chief Population Health Office Phil Oravetz, MD.

Below, Oravetz discusses the need-to-know facts for Ochsner Health Network clinicians regarding this great step towards removing racial disparities in medical diagnostics and scaling better access to top quality healthcare:

1. What’s the issue with using the traditional eGFR for evaluating kidney function?
   Recently, healthcare studies showed that factoring race into CKD diagnostic calculations, namely the eGFR, led to delays in specialty referral care, kidney transplantation and poorer outcomes among Black/African American patients.
   
   Data indicate that Black/African American patients experience higher risks for developing chronic kidney disease (CKD), including the development end-stage renal disease (ESRD). Old diagnostic equations reported different values for Black/African Americans and non-Black/African American patients, assuming that Black/African American patients had higher muscle mass. In turn, studies point to under-diagnosing CKD and ESRD among Black/African American patients, leading to greater risk, progression of disease, and worsened outcomes.
   
   
2. What can patients and clinicians expect with the new eGFR?
   Now live in EPIC, removing race from the eGFR value will increase the sensitivity of the calculation for patients with chronic kidney disease.
   
   Practical Implication : More patients, particularly Black/African Americans, will appear to have lower eGFRs than prior to this change by approximately 16%, and this may cause some anxiety for the patients with a new “abnormal” lab value.
   Clinical Implication: Patients being considered for renal transplant will be more likely to reach transplant evaluation threshold and in a shorter time when the race parameter is not used, as guidelines advise an eGFR threshold of <20 mL/min before moving to transplantation evaluation.
   
   
3. What will the potentially higher CKD incidence among my patient panel mean for performance data?
   Our physician and clinical advisory groups agree that this is the absolute “right thing to do.” While prevalence rates might increase initially, we expect to see improvements overall… using Ochsner Health Network’s population health tools and support services, metrics in disease management, outcomes and mortality rates should trend more favorably.