The University of Maryland Medical System is doing away with an algorithm that for decades determined the kidney health of patients. The calculations from blood tests may have stripped thousands of African American patients from getting proper timely treatments.
The medical system and the University of Maryland School of Medicine said this week that they will stop using the methodology.
鈥淲e now recognize increasingly across medicine that race is a social construct and not a biologic construct,鈥� said University of Maryland Medical System nephrologist Dr. Stephen Seliger. 鈥淎nd race doesn鈥檛 have an appropriate role in these medical measurements.鈥�
Advocates say the algorithm may have cost thousands of African American patients from getting lifesaving transplants. And, thousands of Black patients across the region could be affected by the move to drop the calculation.
鈥淧eople who identify as African American are less likely to have access to kidney transplants and one possible explanation for that is a delay in referral because their kidney function is being estimated as being better than it actually is,鈥� Seliger said.
Here鈥檚 how the algorithm works:
- Doctors draw blood from a patient’s muscles to measure creatinine, which reveals how well a person鈥檚 kidneys are cleaning the blood.
- After physicians get the results, they calculate in the patient鈥檚 race. If the patient is Black, the equation usually deemed healthier kidneys.
- For all other patients 鈥� even with the same test results, age and gender 鈥� the algorithm frequently lowered the level of kidney health, leading to a diagnosis of kidney disease.
鈥淚t was based implicitly on a belief that people of African ancestry had higher levels of muscle mass, and the blood test that we鈥檙e measuring is derived in part from skeletal muscle,鈥� Seliger said. 鈥淚t鈥檚 not really grounded in particularly any good data. It鈥檚 almost certainly a fallacy.鈥�
Because the algorithm determined that many Black patients had better kidney health, doctors often missed early onset kidney disease, which is difficult to detect, Seliger said.
鈥淢ost people don鈥檛 have readily recognizable symptoms that will indicate its presence,鈥� he said. 鈥淚t鈥檚 therefore necessary that laboratory testing is essential for making the diagnosis.鈥�
A nationwide social justice movement brought the issue to doctors鈥� attention at the National Kidney Foundation and the American Social Nephrology, two of the country鈥檚 leading medical research groups.
The nationwide to stop using the calculation immediately.
As Seliger and his team work to remove the algorithm, he said one of the key components include educating patients and doctors.
鈥淢y advice to patients is to understand that medical knowledge evolves over time,鈥� Seliger said. 鈥淗ave an honest conversation with their providers. Moving forward we need to make sure doctors can explain to their patients why they鈥檙e re-estimating their kidney function. And, that re-estimation may lead to a reclassification of the patient.鈥�
