Is eGFR racist and what does it mean if people decide it is?

There’s a lot of community discussion happening about racism at the moment, so I thought this week we might highlight one of the areas that’s specifically relevant to health - race and kidney disease.

I only came across the idea that race should be removed as a variable from eGFR calculations a month or so ago when I saw a celebration that a lobbying group had successfully had the algorithm changed in their local health institution. I couldn’t figure out if this was based on science (i.e. it’s not true that race effects muscle mass and CrCl so seems like a totally reasonable thing to do) or social activism. Truthfully, I’m still unsure. I often find it difficult knowing what sources to trust these days, and where the truth lies. But I think these are the sorts of issues we need to not only be aware of, but understand, and there are limited places to discuss it with the sort of nuance that it deserves.

Thinking about CrCl and social activism doesn’t just apply to race, but also debates regarding sex and gender. If the legal situation evolves that individual’s self-identify gender and that biological sex doesn’t need to be disclosed, what impact will this have on estimating renal function?

Honestly, I’m not really sure where I stand on this stuff, but it’s something I’m trying to learn more about so that I feel confident my opinion is well informed. If there’s anyone who has any knowledge to contribute or also wanting to learn about it and explore the issues further I’d really welcome the discussion.

Here are a couple of readings to get you thinking if this is new to you - one from August 2019, the other from 2005 which includes an interesting section on socio-cultural impact on kidney disease (figure below).


And another from the Journal of the American Society of Nephrology