Person undergoing dialysis to treat a kidney condition Science Photo Library
The UK Medical Guidance has removed a controversial recommendation to alter kidney test results based upon a person's ethnicity.
The estimated glomerular filter rate (eGFR) is a measure of kidney function. It's used to evaluate the rate at which kidneys filter waste. The UK's National Institute for Health and Care Excellence recommended that correction factors be applied to GFR values for individuals of African-Caribbean and African family origin. This recommendation was in effect until 25 August. This recommendation to adjust the eGFR based upon ethnicity was removed from an updated version.
NICE has updated its guidance. This comes as more doctors and researchers question the use of ethnicity and race adjustments in medical tests. They also highlight the lack of evidence supporting their use and the potential harm it can cause.
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Rouvick Gama at Kings College Hospital in London and Kate Bramham from Kings College Hospital found that the inclusion of ethnicity adjustment in eGFR equations can overestimate Black people's actual GFR by around 25%. They concluded that this could lead to a lower diagnosis of chronic kidney disease in Blacks and an underestimation for disease severity in Blacks living in the UK.
Paul Cockwell, president, UK Kidney Association, said that we support and welcome this change. We encourage all renal services, including clinical laboratories, to work with electronic clinical system developers and remove any adjustment for Black ethnicity in eGFR creatinine reporting.
He says that race and ethnicity are social constructs that do not correspond to genetic categories. Ethnicity can lead to an underestimation of kidney function, and possible inequalities in the delivery of care.
NICE informed New Scientist that the guideline committee recognized that GFR should not be adjusted for African-Caribbean and African family origin people. There were many variables in the evidence that meant it was more appropriate for individual risk factors to be taken into consideration.
New guidance suggests that biomarkers are investigated in order to improve diagnostic accuracy for eGFR calculations.
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