Health inequities and the inappropriate use of race in nephrology

Abstract

Chronic kidney disease is an important clinical condition beset with racial and ethnic disparities that are associated with social inequities. Many medical schools and health centres across the USA have raised concerns about the use of race — a socio-political construct that mediates the effect of structural racism — as a fixed, measurable biological variable in the assessment of kidney disease. We discuss the role of race and racism in medicine and outline many of the concerns that have been raised by the medical and social justice communities regarding the use of race in estimated glomerular filtration rate equations, including its relationship with structural racism and racial inequities. Although race can be used to identify populations who experience racism and subsequent differential treatment, ignoring the biological and social heterogeneity within any racial group and inferring innate individual-level attributes is methodologically flawed. Therefore, although more accurate measures for estimating kidney function are under investigation, we support the use of biomarkers for determining estimated glomerular filtration rate without adjustments for race. Clinicians have a duty to recognize and elucidate the nuances of racism and its effects on health and disease. Otherwise, we risk perpetuating historical racist concepts in medicine that exacerbate health inequities and impact marginalized patient populations.

Abstract

Here, the authors discuss how structural racism underlies many of the health disparities that affect individuals from minority racial groups. They also examine how the use of race coefficients in estimated glomerular filtration rate equations might contribute to health inequities in Black patients with kidney disease.

Key points

• Race and ethnicity are socio-political constructs that are inextricably tied to health outcomes for individuals from racial and ethnic minority groups worldwide.

• Historically, science has developed and relied on racial frames to artificially organize people into presumed homogeneous and genetically distinct racial groups, to suggest that inherent biological differences exist between the groups.

• The use of race coefficients in estimated glomerular filtration rate equations reinforces flawed assumptions of race essentialism and potentially perpetuates health inequities for Black individuals with kidney disease.

• Valid and race-free methods of kidney function estimation should be used to promote high-quality science, guide clinical management decisions and decrease racial bias.