Race-Based eGFR Calculation Changes Boost Kidney Transplants for Black Patients

For decades, a standard test used to measure kidney function, the estimated glomerular filtration rate (eGFR), included a race-based calculation that systematically underestimated kidney function in Black patients. This led to delayed diagnoses, hindered access to care, and fewer opportunities for life-saving kidney transplants. Recent changes to remove race from the eGFR calculation, coupled with policy adjustments from the Organ Procurement and Transplantation Network (OPTN), are showing promising results, significantly increasing transplant rates for Black candidates.

The History of Race-Based eGFR

Until 2021, the eGFR calculation included a coefficient based on race, inflating results for Black individuals by as much as 21%. This meant that Black patients were often misdiagnosed with better kidney function than they actually had, delaying referrals to specialists and potentially preventing them from being considered for transplant. The practice stemmed from historical assumptions and systemic biases, rather than genuine physiological differences.

The Shift Towards Race-Neutral eGFR

In September 2021, a task force led by the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) recommended removing race as a factor in the eGFR calculation. This decision followed extensive debate and advocacy from health equity groups. The new CKD-EPI 2021 equations were developed without a race coefficient and demonstrated improved precision. Labs began updating their reports, but it was crucial for doctors to adopt the new, race-neutral equations.

Impact on Kidney Transplantation

The OPTN implemented a policy in 2023 to provide wait time modifications for Black transplant candidates to address the historical harms of the race-based eGFR calculation. A recent study examining data from over 180,000 candidates—56,000 of whom were Black—revealed a significant impact. The change resulted in an estimated 5.3 more transplants per 1,000 Black candidates, representing a 27% impact on this population.

Importantly, the study found that the policy did not negatively affect transplant rates for non-Black patients, debunking concerns that improving outcomes for one group would come at the expense of others. Researchers cautioned that increased kidney availability in recent years may have likewise contributed to this outcome.

Ongoing Challenges and Future Directions

While the changes represent a crucial step forward, racial disparities in kidney transplantation persist. Research suggests that the wait time adjustments have primarily benefited patients with consistent access to healthcare and recent lab values. Patients who experience sudden kidney failure or lack regular access to care may not benefit as much from the current policy.

Researchers are now focusing on addressing these remaining inequities and exploring opportunities to remediate the effects of other race-based medical tests, such as those used in pulmonary function testing for worker compensation claims. The removal of race from the eGFR calculation serves as a model for addressing systemic biases in healthcare and promoting equitable access to life-saving treatments.