The Barriers: Chronic Kidney Disease and Racial Disparities in Healthcare
The higher number of Black Americans with kidney failure compared to the lower number of White Americans with kidney failure is a gap or health disparity. A health disparity is the difference in quality of care or health outcomes for a nonminority group compared to a minority group.
Higher rates of diabetes and high blood pressure in Black communities are factors that contribute to this disparity. However, many other barriers influence onset or progression of chronic kidney disease (CKD). These barriers are sometimes called social determinants of health. They include income, employment, education, housing, insurance status, and access to healthcare.
For example, diagnosis and treatment of kidney disease often are delayed for Black patients who have poor access to healthcare. It is estimated that more than 30% of patients who have CKD haven’t seen a nephrologist by the time their kidneys fail. (Ricardo AC, Roy JA, Tao K, et al. Influence of Nephrologist Care on Management and Outcomes in Adults with Chronic Kidney Disease. J Gen Intern Med. 2016;31(1):22-29. doi:10.1007/s11606-015-3452-x) Often times, more than 80% of kidney failure has occurred before a referral to a nephrologist. Without timely treatment, CKD can progress more quickly to kidney failure.
Barriers to Transplant Access
Black Americans with kidney failure have lower access to transplantation. While Black Americans account for 35% of people receiving dialysis, they are less likely to be identified as kidney transplant candidates compared to White Americans. Black patients with kidney disease often encounter barriers throughout the steps to transplant access:
Impact of the eGFR Race Correction
A race correction multiplier is often used in calculating eGFR. This multiplier can prevent Black Americans from getting timely treatment to slow the progression of chronic kidney disease.
What is eGFR?
Estimated glomerular filtration rate (eGFR) is the measure of kidney function. eGFR ranges are from 0 to 140 mL/minute. The normal rate is at least 90 mL/minute. A number less than 60 mL/minute indicates kidney disease. eGFR may vary from person to person. Healthcare providers use eGFR to help decide when to refer a patient for transplantation.
Why Do Different People Have Different eGFR Scores?
The eGFR is calculated from the amount of creatinine in the blood using a math equation. Different people can have different creatinine levels in their blood. This difference is not always related to kidney disease. It can be affected by other factors, such as age, sex, and body size. Several equations use race as a factor in eGFR calculation. Sometimes the eGFR for a Black patient is multiplied by 1.2 or 1.6, depending upon the formula. However, unlike age, sex, and body size, race is a social construct. It is not biological. Because of this, many healthcare providers and hospitals no longer include race as factor when calculating eGFR.
What Impact Does Race Correction Have on Black Patients?
Using race as a factor when calculating eGFR can create barriers to treatment for Black patients. The multiplier for race can make Black patients seem to have better kidney function than they actually do. These patients are delayed in triage to a nephrologist as well as wait list referral. The race correction can also delay patient education about transplant options and prevents dose-reducing medicine.