M Health Fairview to end race as a determinant in kidney health

Nkauj Shoua Vang/M Health Brooke Cunningham

M Health Fairview will no longer use race as an automatic adjustment in determining kidney health, following recommendations from a task force of its physicians convened last summer.

For decades, healthcare providers nationwide have automatically adjusted one measurement of kidney health—the estimated glomerular filtration rate (eGFR)—based on the race of the patient. Black patients had one set of guidelines, non-Black patients had another.

Based on the incorrect assumption that race is biological, the adjustment can make Black patients’ kidneys seem healthier than they may really be. This can lead to delays in both getting advanced care and being listed for a kidney transplant, if necessary. M Health Fairview will no longer use race as an automatic adjustment when determining eGFR.

“When we evaluated the effect of this practice on patient care, we found it at best, problematic,” said M Health Fairview Hospitalist Kristina Krohn, MD. Krohn, who also serves as an assistant professor in the Department of Medicine at the University of Minnesota Medical School, chaired the task force. “As we find a better way, we need to stop doing what we know is causing harm.”

Leading healthcare organizations across the country are beginning to reevaluate calculations like these, driven in part by the grassroots efforts of scientists, providers, medical students, and the nationwide racial justice movement.

“Medicine has to reckon with its role in the process of justifying exploitation and oppression,” said M Health Fairview Internist Brooke Cunningham, MD, Ph.D. Cunningham was a member of the eGFR task force and serves as an assistant professor in the Department of Family Medicine and Community Health at the University of Minnesota Medical School. “We need to interrupt that legacy, and one way to do that is by interrogating the ideas grounding these calculators and algorithms. If the origin of the calculator is based on a biological construction of race, we need to change it.”

M Health Fairview physicians established their task force in June 2020 and ultimately recommended removing the race-based adjustment. At the same time last summer, the health system took another important step toward eliminating structural racism in healthcare – forming the Healing, Opportunity, People, and Equity (HOPE) Commission. The guiding principles of the HOPE Commission inform decisions across M Health Fairview, and the removal of the automatic eGFR adjustment is one example.

“M Health Fairview is taking a critical look at the way it operates on both very granular levels, such as this, and on broader levels,” said Internist and Pediatrician Taj Mustapha, MD, a member of the eGFR task force and M Health Fairview’s HOPE Commission. Mustapha is also an assistant professor in the Departments of Medicine and Pediatrics at the University of Minnesota Medical School.

 “Reckoning with the inequities and flawed constructs that are embedded within healthcare and medicine will take time and work, and this is just one example of such work that is happening across the enterprise.”

Removal of the race-based eGFR adjustment will go into effect at M Health Fairview in July.