How is race or ethnicity related to eGFR?

So just to explain that a little bit, previously, black race was used in the formulas that estimate theGFR and this was done because the initial clinical trials that we had came up with formulas for the EGFR based on the population that they had. They had a smaller number of black patients, but in that it suggested that theGFR for black patients may be higher based on those trials and that was used for years. Those formulas were used for years. But as we have become more aware of race being a social construct and it being a really complex topic or area because individuals who self-identify as black is self-identification, it's not a biological based construct. And then additionally, people who identify as multiracial, how do you con for that?

And then another thing to keep in mind in these clinical trials, black race was the only one that is uniquely in the formulas. Other races were not used in the formulas to account for how their EGFR might be different. So it was either blacks versus all others kind of pulled in together. And so this meant that individuals who self-identified as black when they were reporting this to their physicians or to the lab and were having their kidney function test, their EGFR was calculated slightly higher for other individuals who might have all the other factors the same including age, sex body type. And so that would mean for example, patients with advanced kidney disease, so chronic kidney disease, stage four, nearing stage five, who would otherwise be listed for transplant if they were black, they were getting listed later for transplant and that meant they would accumulate less time on the transplant wait list before they needed to go on dialysis

And that is a huge implication. And so, in 2021 there was a national kidney task force both from the American Society of Nephrology and National Kidney Foundation that announced a new race free equation for EGFR, which has been implemented in many hospitals and labs across the country. Of course whenever there is a change that's implemented, there's downstream effects. One of the downstream effects was now individuals who had self-identified as black who had a higher eGFR, all of a sudden now within a span of a month when the labs changed, their EGFR dropped by 7 to 10 points. And that was, that's huge because nothing has changed with your body, but now you're being told your kidney function is actually lower than what you previously thought it was. So a lot of adjustment for individuals across the board, good for patients who needed to be referred for transplant and for physicians who could do that referral however, required a lot of discussion to enable people to understand the implications of this new change. But I think a really positive change where we've taken race out of the measurement for glomerular filtration rate.

Yeah, so whenever I looked at my lab results, it would say EGFR if black, then this if not black, then this. So my EEG F r was always calculated as being higher. And so when these changes were being made, initially I was really surprised because I said, oh my gosh, so many people now, so many African-American people now are going to be under that umbrella of chronic kidney disease. But as Dr. Chari stated, it's actually a good thing because it's allowing for quicker services as far as transplant or treatment for chronic kidney disease. So it's a good thing. It definitely is a good thing

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