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Workgroup to examine use of race-based adjustment to kidney calculation

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UNOS News Bureau

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The Organ Procurement and Transplantation Network (OPTN) has formed a workgroup to study the use and impact of a race-based adjustment to a common measure of kidney function known as the estimated glomerular filtration rate (eGFR). Workgroup participants include members of the Minority Affairs and Kidney Transplantation Committees and additional subject matter experts.

 “The organ donation and transplantation community is committed to addressing disparities in transplant equity,” said Irene Kim, M.D., FACS, chair of the OPTN Minority Affairs Committee and a workgroup member. “The establishment of this workgroup and its study is an important step in understanding the most relevant factors that influence a patient’s chance to receive a kidney transplant.”

The eGFR (estimated glomerular filtration rate) measures the rate at which the kidneys remove waste products from the blood. It can be calculated from a routine blood test, unlike other measures of kidney function that involve urine testing. Some measures of eGFR include an adjustment for individuals identified as Black. A number of researchers and social advocates have called for the elimination of this adjustment due to its being based solely on ethnic identity and not clinically relevant factors.

 “The medical profession is increasingly interested in the influence race-based calculators have on various medical treatments,” said Martha Pavlakis, M.D., vice chair of the OPTN Kidney Transplantation Committee and a workgroup member. “We need to understand and correct the way that some calculations of eGFR are adjusted for people identified as Black and how these contribute to disparities in transplant access for Black transplant candidates.”

Current OPTN policy contains numerous references to eGFR, including a determination of the point at which kidney candidates begin accruing credit for transplant waiting time and metrics to evaluate kidney function for donor organs. OPTN policy does not specify any method or formula clinicians should use in calculating the rate, just that it is accurately reported and based on verifiable test results.

The workgroup will study the use of racially adjusted eGFR calculation in transplantation and its effects on treatment of transplant candidates and recipients. The workgroup will issue recommendations to appropriate OPTN committees for further consideration and action.

The members of the workgroup are as follows:

Irene Kim, M.D., FACS

Cedars-Sinai Medical Center

 

Paulo Martins, M.D., Ph.D.

UMass Memorial Medical Center

 

Alejandro Diez, M.D.

Ohio State University Medical Center

 

Oyedolamu Olaitan, M.D., M.B.B.S.

Rush University Medical Center

 

Oscar Serrano, M.D.

Hartford Hospital

 

Denise Alveranga, M.D.

Tampa General Hospital

 

Martha Pavlakis, M.D.

Beth Israel Deaconess Medical Center

 

Jim Kim, M.D.

Keck Hospital of USC

 

Precious McCowan, M.S.

Transplant recipient

 

Beatrice Concepcion, M.D.

Vanderbilt University Medical Center

 

Arpita Basu, M.D., M.P.H.

Emory Healthcare

 

Amaka Eneanya, M.D., M.P.H. FASN

University of Pennsylvania School of Medicine

 

Peter Reese, M.D., MCSE

Hospital of the University of Pennsylva