A controversial recommendation to adjust kidney test results based on a person’s ethnicity has been removed from UK medical guidance.
Kidney function is routinely assessed using an equation that estimates the rate at which a person’s kidneys filter waste, known as their estimated glomerular filtration rate (eGFR). Until 25 August, guidelines from the UK’s National Institute for Health and Care Excellence (NICE) recommended applying “a correction factor to GFR values… for people of African-Caribbean or African family origin”. In an updated version of the guidance, this recommendation to adjust eGFR based on ethnicity has been removed.
The updated NICE guidance comes as a growing number of doctors and researchers have been questioning the use of race and ethnicity adjustments in medical tests, and highlighting the lack of evidence to support their use and the potential harm they can cause.
A recent study led by Rouvick Gama and Kate Bramham at King’s College Hospital in London found that the use of ethnicity adjustment in eGFR equations overestimates actual GFR in Black people by about 25 per cent. This may lead to reduced diagnosis of chronic kidney disease and underestimation of disease severity among Black people in the UK, they concluded.
“We welcome and support this change and are encouraging all renal services to work with clinical laboratories and/or electronic clinical system developers to remove the adjustment for Black ethnicity from eGFR creatinine reports,” says Paul Cockwell, president of the UK Kidney Association.
“Ethnicity and race are social constructs and do not match genetic categories,” he says. “Adjusting for kidney function based on ethnicity could lead to an overestimation of kidney function and potential inequality in delivery of care.”
NICE told New Scientist: “The guideline committee recognised that the estimation of glomerular filtration rate (GFR) should no longer be adjusted for people of African-Caribbean or African family origin. This was due to a number of variable factors in the evidence which meant it was more appropriate to take into account individual risk factors.”
The new guidance recommends that biomarkers be investigated to improve the diagnostic accuracy of eGFR calculations.
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