I recently watched an episode of Grey’s Anatomy where they discussed a medical term called the Estimated Glomerular Filtration rate or eGFR score. As mentioned in the episode, a patient with severe diabetes was diagnosed with kidney failure and needed a kidney transplant. She failed to qualify for the transplant list based on her eGFR scoring. The episode served to highlight the inequalities in the healthcare system for people of color. In this fictional depiction, the patient was able to meet all of the criteria to make the transplant list, however, she was discounted due to one of the determining factors on the eGFR scale. The fact that she was a Black woman kept her from being on the list due to her race. There has been a pressing movement to remove race from estimating kidney function due to the negative impact this practice has shown to have on communities of color where there is already documented evidence that kidney disease disproportionately impacts them.
The Consequence
There has long been a debate and discussion on racial equity within our healthcare system and also the inherent systemic racism that has been built into the system and healthcare setting. According to the National Kidney Foundation, “Estimated glomerular filtration rate (eGFR) is one of the primary diagnostic methods for detecting and managing kidney diseases. The eGFR equation includes age, sex, race, and/or bodyweight to approximate directly measured kidney function. However, race is a social, not a biological, construct.” How do you correct an issue that is deeply rooted in our society’s medical system? Or even worse, how do you address an issue you are not aware even exists? This is why it is critical to ask questions. Your medical provider or medical team should and is obligated to break things down in layman's terms so that you can understand your diagnosis and most importantly, your treatment options. What may seem like the obvious inquiry to so many often is not. You hear about certain test scores or results and may find them confusing. Additionally, you may not realize that some tests and institutional metrics could be biased towards you. A person’s race is an unfair determining factor within the eGFR method especially if the person is able to hit the other markers that would otherwise allow them to be eligible for a kidney transplant.
A kidney transplant can be a matter of life and death for many who suffer from kidney disease. People from various races, whether Black, Latino, Asian or Native American often already face disparities and inequality in treatment within healthcare settings and are also most impacted by the disease. When seeking treatment options, there can be instances such as with the eGFR where advantageous outcomes are not geared towards helping populations from various racial backgrounds. This sets a dangerous precedent that puts many behind in getting adequate preventative treatment as well as after-diagnosis treatment options. Seeking treatment options that were not designed considering proper metrics for all minorities sets a dangerous precedent that should have been corrected by now.
The Recovery
In order to improve healthier outcomes and treatment options for those suffering from kidney disease, we need our healthcare community to be up to date with developments and studies. We need our healthcare providers to be aware of racial inequities and recognize that there is no “one size fits all” approach, particularly when the approach put in place is disadvantageous to others. It may seem impossible to fix a healthcare system entrenched with so many biases, however, with recent studies highlighting disparities, we can demand better.
It is long overdue that our community demands more from our healthcare professionals. Whether we are looking at tests or drugs that did not include clinical trials with people from our race, or some healthcare professionals not taking the time to educate themselves on how institutional healthcare biases can impact treatment plans and options for their patients of a different race, we deserve better. Healthier outcomes start with examining what is broken so that it can be fixed, not settling on using the same things we know that will not provide the best or most accurate results for all patients.
This can be daunting if a person does not know what biases exist, therefore, it is paramount that you be your strongest advocate. It is not required that you be an expert, just be an expert at asking questions and seeking following up guidance or opinions on things that may seem off to you. Research your provider and try to find out their experience with dealing with multiple scenarios and patients across all races. In this country there are over 30 million people that have kidney disease and some may not have any warning signs until it is too late. It is imperative to ask your healthcare provider about what tests are needed for prevention and what the results mean for you as an individual and not just a broad-based result. As stated by the National Kidney Foundation, “Risk factors for kidney diseases include diabetes, high blood pressure, heart disease, obesity, a family history of kidney failure, and being age 60 or older." Minority groups can have increased risk, hence it is imperative that healthcare systems and measures in place reflect that and address fixing inequalities like biased measures including tests and requirements to gain access to life-saving treatments. We all deserve to have healthcare built for us.