Adopting a Race Neutral Approach to Kidney Disease

Published in Hopkins Medicine - Spring/Summer 2022

The Johns Hopkins Health System will no longer use a long-standing clinical standard that factors a patient’s race into kidney function tests. The transition to a new standard of evaluating kidney function will specifically eliminate whether a patient is “African American or non-African American” as a modifier to check how well a patient’s kidneys are working. The change to the new race-neutral assessment means thousands of Black people living with chronic kidney disease could gain access to specialty treatment or transplantation for the first time.

Removing race from the calculation for kidney disease follows recent national recommendations from both the National Kidney Foundation and the American Society of Nephrology that say race modifiers should not be included in equations used to estimate kidney function because race is a social, not a biological, construct.

“There are not biological differences in the kidney attributable to race, and therefore it should not be considered in the equation for kidney function,” says Sherita Golden, chief diversity officer at Johns Hopkins Medicine. “This is an evidence-based decision that is really important in potentially narrowing gaps in kidney disease disparities. I’m proud of our leadership for taking this necessary step toward achieving health equity and eliminating structural racism in medicine.”

“Eliminating the race-based adjustment may lead to several positive clinical outcomes, including more time for management and referral of early kidney disease, earlier consideration for transplant listing and more careful medication decisions for Black patients,” says Johns Hopkins nephrologist Deidra Crews, a member of the task force that recommended the new equation. “Time is of the essence; if a patient does have kidney disease, finding out earlier could make a difference in the person’s long-term health.”

According to the National Kidney Foundation, there are 37 million people in the United States living with chronic kidney disease, with Black adults three times more likely to suffer from kidney failure than white adults.