UW med school risks 'misclassifying' kidney disease to 'address systemic racism'

The test could lead to misclassification of kidney disease for about 10 percent of patients.

Citing “anti-racism,” the University of Wisconsin School of Medicine will amend its kidney function test so that it will not include race.

The University of Wisconsin School of Medicine and Public Health will amend its process of testing for kidney function “to address systemic racism.” However, doing so comes at the risk of misclassifying 1 in 10 patients, per the school’s own admission. 

A University of Wisconsin press release cited UW professor Arjang Djamali, who said that race should not be utilized to determine kidney function because it is a social construct rather than a biological one. The formula for estimating glomerular filtration rate (GFR), which is utilized to assess kidney function, is based upon two factors. One is the amount of the protein creatinine in the bloodstream. The other is race; studies indicate that it is a predictor for GFR, with Black people tending to have higher GFR than White people.

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“Essentially, this calculation would often suggest that a Black patient’s kidney function is better than what it really is,”  Djamali said. “These are the reasons race needs to be eliminated from the formula.” 

Djamali stated that concerns about systemic racism fueled the decision: “We strongly encourage all health systems to follow this example, and for everyone in the practice of medicine to intentionally engage in anti-racism efforts.”

However, the University of Wisconsin press release acknowledged that “removing race from the creatinine-based formula could have the unintended consequence to misclassify the stage of kidney disease for about 10% of patients.”

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”To help correct this, Djamali and his multidisciplinary team of colleagues propose using a confirmatory cystatin C-based GFR test when accurate kidney disease staging is considered. The cystatin C-based GFR test does not rely on a race-based assumption,” UW said.

Djamali told Campus Reform that the new C-based GFR test will “reduce the risk of misclassification to less than 5-6%.” 

However, he explained that “for cases requiring even more accurate determinations, we can actually measure 24-hour creatinine clearance or imaging-based GFR measurements.” Furthermore, the risk of misclassification “would primarily affect cases with higher levels of kidney function rather than patients with a need for treatment at lower levels of kidney function.”

Campus Reform reached out to the University of Wisconsin for comment; this article will be updated accordingly.

Follow the author of this article on Twitter: @BenZeisloft