The Council of Medical Specialty Societies (CMSS) has awarded $100,000 to ASN, advancing its ongoing work to promote equity in kidney care by teaching nephrologists and other clinicians how to use race-free algorithms for assessing kidney function (1).
The ASN-National Kidney Foundation (NKF) Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Diseases in 2021 recommended widespread adoption of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) algorithm with creatinine or creatinine and cystatin C instead of a previous race-corrected algorithm (2). The goal was to provide a more accurate assessment of kidney function for all patients and to help eliminate persistent delays in referral and transplant care for Black patients. The CMSS grant will support a multipronged educational campaign to help ASN’s 21,000 members learn about the algorithm and how to apply it in practice and to help teach their fellow clinicians and patients about its use in medical decision-making.
“The CMSS grant will help accelerate our efforts to provide nephrologists and other kidney health professionals with the latest information about eGFR [estimated glomerular filtration rate] and equip them to discuss the new metric with their patients with kidney diseases,” said ASN’s Executive Vice President Tod Ibrahim in a statement about the grant (3).
Diagnostic excellence
ASN was one of 11 medical specialty societies that received a grant from CMSS’s 2023–2024 Promoting Diagnostic Excellence Across Medicine program (1), funded by the Gordon and Betty Moore Foundation and the John A. Hartford Foundation. Several of this year’s grantees, including ASN, are focusing their projects on improving diagnostic equity, reflecting a growing push within CMSS and its 51 specialty society members to reduce health disparities. “Equity is among the top priorities of all our societies right now,” said Helen Burstin, MD, MPH, FACP, executive vice president and chief executive officer of CMSS.
Many medical specialty societies are currently reconsidering the use of race in clinical decision-making tools, according to a recent CMSS report (4). This reflects growing recognition in medicine that race is a social construct and not a proxy for biology and that inappropriate use of race as a biological proxy may contribute to or exacerbate health disparities. The ASN-NKF task force’s 2021 recommendation to adopt new race-free equations placed it at the head of the curve. Work by the two organizations has advanced well into the implementation phase, with approximately two-thirds of US laboratories reporting that they have implemented the race-free eGFR equation (5).
“ASN and NKF were early adopters in this space and, in many ways, are helping lead the way for other specialty societies,” Burstin said. She noted that the speed of race-free eGFR implementation has been remarkable for medicine, which can often take a decade or more to implement new recommendations.
Cynthia Delgado, MD, FASN, co-chair of the ASN-NKF task force and a professor of medicine at the University of California, San Francisco, credited ASN’s leadership for recognizing the importance of moving quickly to address the use of race in kidney function assessment, an issue about which members were increasingly expressing concerns. Delgado, then chair of ASN’s Diversity, Equity, and Inclusion (DEI) Committee, said Ibrahim worked with the DEI Committee and NKF to assemble a task force that included 15 independent thinkers who represented a broad spectrum of the kidney care community.
“It was an all-hands-on-deck moment,” she said. NKF took the lead on the initial implementation phase, providing guidance (6) and outreach to laboratories to expedite the implementation of the race-free eGFR. Implementation has had widespread downstream effects. For example, the United Network for Organ Sharing (UNOS) has since required transplant centers to use the race-free eGFR equations for transplant evaluations and to recalculate waitlist times for Black patients whose care may have been delayed by the race-adjusted algorithm (7). Burstin said she hoped the grant would help expand the adoption of the race-free eGFR even further, reaching the remaining clinicians who still need to make the switch.
Other 2023–2024 grantees working to address racial and ethnic disparities in diagnoses include the American Academy of Dermatology, which will use its grant to improve dermatologists’ ability to diagnose skin conditions across skin tones, and the American Urological Association, which is developing a campaign to educate urologists and primary care specialists about the importance of early screening for prostate cancer for those at increased risk associated with Black ancestry, germline mutations, or a family history of prostate cancer, to help reduce disparities in outcomes in these groups. “We hope our efforts will inspire other medical societies to [review] long-established standards of care to identify and eliminate race-based disparities,” Ibrahim said in the ASN statement (3).
Multipronged campaign
The CMSS grant will fund a multipronged outreach campaign to clinicians about race-free eGFR and its use in patient care. Delgado noted that clinicians use eGFR across specialties, including primary care, radiology, oncology, and pharmacy. She said ASN wants to ensure that the campaign’s reach matches this clinical tool’s reach. “We are going to work on further educating our nephrology colleagues and trainees,” she stated. “I hope we create ambassadors who can educate non-kidney specialist [clinicians] on how to use the equation.”
Burstin, a primary care general internist, said it is essential for clinicians across specialties to understand the new eGFR results and how to use them in clinical decision-making. She noted, for example, how to use the estimations in prescribing medications, such as the new classes of cardiometabolic drugs, or the implications for patients who may be candidates for transplant.
While the details of the educational materials are just beginning to be determined, Delgado said, one key point she hopes to include is that eGFRs are just estimates and are only one piece of kidney function assessment. She noted that the same is true for kidney transplant evaluation and that the new UNOS recommendation (7) reflects one small change in the complex algorithm that involves many other factors beyond eGFR. “We want to err on the side of being more ethical, fair, and equitable,” she said.
Delgado shared that she and her ASN colleagues also hope to prepare nephrologists to discuss the eGFR algorithm comfortably with their patients in easy-to-understand terms. “It’s very important for [patients] to understand how we think so they can also be advocates for themselves and their own health care,” she said.
ASN will convene a group of kidney care specialists over the coming months to develop the educational tools and begin their rollout. The society will also likely collaborate with other partners such as NKF. “We will approach this work as we always do with collaboration from others,” she said.
Delgado expressed that she is proud that ASN and NKF are leading the charge to eliminate the inappropriate use of race in clinical algorithms across specialties, which will ultimately change how medicine is practiced. “The kidney community at large should be very proud that we are on the cutting edge of this work and that we are making changes that will be lasting,” Delgado said.
References
- 1.↑
Council of Medical Specialty Societies. The Council of Medical Specialty Societies (CMSS) awards $100,000 grants to eleven specialty societies seeking to improve diagnostic excellence. November 1, 2023. Accessed January 9, 2024. https://cmss.org/press-release-promoting-diagnostic-excellence-grant-awards-copy/
- 2.↑
Delgado C et al. A unifying approach for GFR estimation: Recommendations of the NKF-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease. J Am Soc Nephrol 2021; 32:2994–3015. doi: 10.1681/ASN.2021070988
- 3.↑
American Society of Nephrology. American Society of Nephrology awarded grant from the Council of Medical Specialty Societies to address racial disparities in kidney care. November 28, 2023. Accessed January 9, 2024. https://www.asn-online.org/about/press/releases/ASN_PR_20231128_FINALgrant11.28.23.pdf
- 4.↑
Council of Medical Specialty Societies. Reconsidering race in clinical algorithms: Driving equity through new models in research and implementation. Accessed January 9, 2024. https://issuu.com/jpeterson2022/docs/11279_cmss_report_v4?fr=xKAE9_zU1NQ
- 5.↑
Genzen JR, et al. An update on reported adoption of 2021 CKD-EPI estimated glomerular filtration rate equations. Clin Chem 2023; 69:1197–1199. doi: 10.1093/clinchem/hvad116
- 6.↑
Miller WG et al. National Kidney Foundation Laboratory Engagement Working Group recommendations for implementing the CKD-EPI 2021 race-free equations for estimated glomerular filtration rate: Practical guidance for clinical laboratories. Clin Chem 2022; 68:511–520. doi: 10.1093/clinchem/hvab278
- 7.↑
United Network for Organ Sharing. Implementation notice: Requirement for race-neutral eGFR formulas in effect. July 27, 2022. Accessed January 9, 2024. https://unos.org/news/implementation-notice-race-neutral-egfr-formulas/
