20<\/div>SHARES<\/span><\/div>

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<\/span>Scientific\u200b impartiality is<\/strong><\/span> supposed to prevent politics from influencing the country\u2019s health care decisions.<\/strong> This is no longer true for chronic kidney disease<\/a> (CKD), which is the impaired ability of the kidneys to remove waste,\u2063 toxins, and excess fluids from the blood. This condition affects more than\u2062 35 million<\/a> U.S. adults. However, in the case of CKD, racial politics have\u200d trumped scientific \u200dimpartiality \u2014 and with the blessing of the National Institutes of Health and the leadership of many medical \u200dorganizations. <\/p>\n

<\/span>The diagnosis and<\/strong><\/span> treatment of CKD are guided by\u2063 an overall measure of\u200b kidney health known as the glomerular filtration rate<\/a> (GFR).<\/strong> Although GFR can be directly measured\u2062 in\u200d a hospital or \u200bresearch clinic (the gold standard), in the doctor\u2019s office it is mostly estimated based on creatinine levels in the blood. For over two decades, creatinine levels have been assessed in\u2063 routine screenings and treatment; higher levels of creatinine in the blood are associated with lower\u200b GFR.\u200d The lower the GFR,\u00a0the greater the severity of CKD. <\/p>\n

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<\/span>On average, American<\/strong><\/span> black adults have higher blood\u200d creatinine than non-blacks who \u200bhave the same level of kidney function.<\/strong> A \u201cplausible biological\u200b explanation<\/a>\u201d is that creatinine\u2063 is secreted \u200cinto \u2063the blood by muscle cells, \u200band the average American black adult has \u200dmore muscle than the average non-black adult. In \u200bthe past, this \u200bdifference in creatinine levels was accounted for by a race-correction factor in the GFR formula. \u200bThis \u200dis why blacks tend to have between about a 16 and 21 percent higher<\/a> GFR than non-blacks with the same \u2063creatinine concentrations. <\/p>\n
<\/span>This correction factor<\/strong><\/span> was meant to provide\u2064 black and non-black patients with\u2064 the \u2064same \u200dCKD diagnosis\u200b and treatment based on the best estimate\u200b of \u2062their directly measured GFR, which might \u200cbe different from their\u200b creatinine levels.<\/strong> This \u200bis \u2063why laboratory reports used to show\u2064 two different categorizations of GFR estimates \u2014 one for African\u2064 Americans, and one for others. <\/p>\n
Students and activists successfully petitioned major hospitals to remove the\u2062 race\u2063 correction,\u200d which they characterized as being \u201crooted in historical injustice and a \u2063legacy of justification\u200d for colonization, slavery \u200band genocide.\u201d In addition, many protesters asserted that the\u200b correction factor promoted racism by perpetuating false beliefs that bodies or kidneys are biologically different in blacks and non-blacks.\u2064 A biological race correction also violated the protesters\u2019 fundamental premise that racial health disparities are largely due to racism.\u00a0The \u200ccongressional House Ways and Means Committee also applied pressure to the\u2064 medical establishment for the\u2063 removal of the correction factor. Internet articles and other media<\/a> frequently repeated the claims that race correction was racist. <\/p>\n
Until recently<\/a>, no one challenged the legitimacy \u2064of these claims. <\/p>\n
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No Longer Siding with Science<\/strong><\/h2>\n<\/span>The National Kidney<\/strong><\/span> Foundation (NKF) and the American Society of Nephrology (ASN) are two preeminent national organizations representing kidney patients and \u2063their \u2062treatment\u2062 providers.<\/strong> \u2062 In 2020<\/a>, the NKF\/ASN formed a\u2063 Task Force on Reassessing the Inclusion \u2062of Race in Diagnosing Kidney \u200cDisease, because \u201crecent calls for social justice reform have galvanized segments of the medical community into further discourse and action toward achieving greater health care equity, including the assertion of\u200c race as a social, nonbiological, construct.\u201d <\/p>\n
They decided to remove race from\u2064 the formula for estimating GFR. Their decision was driven not by scientific discussions on the \u2062clinical utility of self-identified race, but rather by the statistically\u2064 irrelevant claim that \u201crace\u201d had no biological basis.<\/strong> <\/p>\n
The exclusion \u2063of race appears to have been a preconceived, agenda-driven choice and not the consequence of rigorous statistical evaluation. Excluding the race coefficient \u2063 produced a statistical bias<\/a> that promotes CKD diagnosis\u2064 in low-risk blacks at the cost of restricting diagnosis in non-blacks.<\/strong> What\u2019s more, the task force ignored their\u200c charge to ensure<\/a> the estimates would: 1) Be \u201cbased on rigorous science\u201d (but no such evidence was ever\u2062 presented), 2) provide an \u201cunbiased\u200d assessment\u201d of kidney function (which turned out to be admittedly biased),\u200b and 3) not \u2064disproportionately affect any one group of individuals (even though it leaves \u2063non-blacks medically disadvantaged). <\/p>\n
<\/span>The Dangers of<\/span> a Politicized Medical Field<\/strong><\/h2>\n<\/span>The task force\u2019s<\/strong><\/span> push for\u200b the immediate adoption of their race-free GFR estimate by clinical laboratories resulted in a 70 percent<\/a> \u200cacceptance as of\u200c October 2022.<\/strong> When fully adopted, the race-free GFR replacement formula is projected to eliminate \u2014 not cure \u2014 CKD diagnoses in just over 5.5 million U.S. whites, Hispanics, Asians, and\u200b other non-black adults who likely have CKD, as well as reclassify previous \u200bCKD diagnoses as less severe in another nearly 4.6 million non-blacks. This \u200dwill all be done \u2062to expand treatment eligibility to 434,000 \u200bblacks who are not likely \u2062to have kidney disease in the first place and to 584,000 \u200cblacks previously diagnosed with less severe cases. <\/p>\n
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<\/span>By removing the<\/strong><\/span> race-correction \u200cfactor, the task force successfully redefined CKD from a disease affecting blacks and whites similarly in the 2015-2018 National Health and Nutrition Examination \u200dSurvey (6.4 percent and \u200b7.7 percent respectively) to one disproportionately affecting blacks (9.3 \u200bpercent and 5.8 percent respectively).<\/strong> Even before the\u2064 task force recommendations<\/a>, many blacks were \u2063more likely than whites to receive drug treatment, undergo \u2062additional testing, \u2063and see a physician specializing\u200b in kidney care. Blacks were\u200b more self-aware of their CKD condition, and treating physicians were also more aware of their black patients \u200chaving CKD. <\/p>\n
Exaggerating the \u200bCKD prevalence in blacks could \u200cexacerbate treatment differences between blacks and non-blacks. Indeed, greater access to \u200btreatment opportunities is the most commonly cited benefit of the race-free estimate of GFR. But decreased\u200b access to treatment in non-blacks is never discussed.<\/p>\n
These and other issues regarding the removal \u2064of race from the diagnosis and treatment of CKD are discussed in-depth \u2062in\u200b a peer-reviewed article<\/a> published in the science journal Cureus<\/em>. This article emphasizes that the purpose of the race-correction factor\u200b has always been to best estimate \u201cmeasured GFR\u201d in a clinical \u200dsetting \u2064based on biomarkers, sex, age,\u200d and patient self-report, including self-reported or clinically assessed race.<\/strong> \u200dThe race-correction \u200dfactor allows for a more\u200d accurate\u200d prediction of GFR. <\/p>\n
We Can\u2019t Ignore the\u2064 Warning Signs<\/strong><\/h2>\n<\/span>Scientific \u200bconsensus committees<\/strong><\/span> play an important role in synthesizing medical literature\u2063 into actionable \u2063treatments via rigorous critical literature review.<\/strong> In \u2063contrast,\u2064 the NKF\/ASN task force cited<\/a> race as \u201ca social\u200b and\u2064 not a biological construct\u201d and\u2064 the \u201cnational call for re-evaluation of the use of race\u200b in clinical algorithms\u201d as reasons for removing the race-correction factor. The adoption of\u200c the race-free GFR estimate appears to have been a fait accompli<\/em> and the creation of a \u200btask force the means to this end.<\/strong> <\/p>\n
While their decision may have been uncritically embraced by the National Institutes of Health and others, it \u200dviolated the \u2063physicians\u2019 duty to base\u200d treatment decisions on \u2064the best available science \u2014 and to deliver the best health care to all. <\/p>\n
<\/span>The issues\u200c raised<\/strong><\/span> go way beyond CKD.<\/strong> The new race-free GFR estimate\u200b may be a harbinger of race-driven changes in medical treatment. When medical practices are dictated by politics rather than science, we endanger public trust in our institutions.<\/strong> <\/p>\n
A recent Gallup<\/a> poll \u200dshows Americans have heretofore\u2064 held members of the medical profession in much higher regard with\u200d respect to honesty and\u2062 ethical standards than journalists,\u200b lawyers, and members of\u2062 Congress. This is a legacy the medical establishment would be foolish to squander.<\/strong><\/p>\n
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What are\u2062 the implications of the immediate adoption\u2064 of a race-free GFR estimate, including potential disparities in CKD diagnoses and treatment eligibility\u2062 between blacks and non-blacks<\/h2>\n
Such as the NKF\u200b and ASN are tasked with making decisions that prioritize scientific evidence and impartiality. However, their\u2064 recent removal of race-correction factors from \u2063the\u200b diagnosis and treatment of\u200c CKD raises concerns about \u200dthe influence of \u200cpolitics on healthcare decisions.<\/p>\n
Chronic \u200ckidney\u200c disease (CKD) is a condition that \u200baffects\u200c over 35 million adults in the United States. The diagnosis and treatment of CKD are guided by the glomerular filtration \u200drate\u2063 (GFR),\u2063 which\u200c measures \u2063kidney\u2062 health. Creatinine levels in the blood are used to estimate GFR, with higher \u200blevels\u2064 indicating lower kidney function.<\/p>\n
One significant factor influencing creatinine levels is race. On\u2063 average, \u2063black adults have higher creatinine levels than non-blacks with the same level of kidney function. \u200bThis difference \u200bwas accounted for by a \u200drace-correction factor in the \u200dGFR formula, ensuring that\u2064 black and non-black patients received the same\u200b diagnosis and treatment based \u2063on their\u2064 GFR.<\/p>\n
However, activists and\u2063 protesters argued that the \u2064race-correction factor\u200b perpetuated racism and false beliefs about biological differences between races. Major hospitals, influenced by these arguments, removed the race-correction factor. The congressional House Ways and Means Committee also applied pressure \u200dfor its removal.<\/p>\n
The NKF and ASN formed a task force\u2063 that recommended the removal of\u2064 race from the GFR formula. Their \u200bdecision was driven\u200d by social justice concerns rather than scientific discussions on the clinical utility of race. This decision led to a statistically biased estimate\u2064 that promotes \u200dCKD diagnosis in \u200dlow-risk blacks while restricting \u200cdiagnosis in non-blacks.<\/p>\n
The\u2063 task force’s\u200d push for the immediate \u2063adoption\u200d of the race-free\u2064 GFR estimate \u2062resulted in a 70 percent acceptance rate. \u2064When fully adopted, the new formula \u200bis projected to eliminate CKD \u2062diagnoses in millions of non-blacks and reclassify previous\u2064 diagnoses\u2062 as \u200cless severe. This expansion of treatment\u2064 eligibility for blacks who are\u200b not \u200clikely\u200b to have kidney disease and for those previously diagnosed with less severe cases raises concerns about the politicization\u200c of healthcare and the \u200cpotential for further disparities.<\/p>\n
By removing the race-correction \u2062factor,\u200d the task force has redefined CKD \u200das\u200d a disease disproportionately affecting blacks. This could exacerbate\u2064 treatment differences between \u2064blacks and non-blacks and \u200cneglect the decreased access to \u200ctreatment for non-blacks.<\/p>\n
These issues regarding \u2062the removal\u200c of race from\u200c the diagnosis and treatment of\u2063 CKD should not be ignored. A peer-reviewed article published \u2063in the\u2063 science journal Cureus argues\u2063 that the race-correction\u2062 factor\u2064 allows\u2063 for a more accurate\u2064 prediction of GFR in \u200ca clinical setting.\u200d Race, along \u200bwith other biomarkers, sex, and age, is an\u200b essential factor in estimating GFR.<\/p>\n
As \u2064we move forward, it is crucial to\u2064 consider \u200bthe\u2062 warning \u2063signs of \u200ca politicized medical\u200b field. Scientific consensus committees must prioritize scientific evidence and impartiality, \u200bensuring that healthcare\u200b decisions are based on rigorous science and not influenced by politics \u200cor social\u2064 justice \u200bconcerns. The implications of\u2062 these decisions can have a significant impact on the diagnosis, treatment, and healthcare outcomes for millions of patients.<\/p>\n","protected":false},"excerpt":{"rendered":"
Chronic kidney disease (CKD), politics have started to influence health care decisions, despite the need for scientific impartiality. CKD, affecting over 35 million U.S. adults, impairs the kidneys’ ability to remove waste and toxins from the blood. Unfortunately, the objectivity that should guide decisions in this field seems to be compromised<\/p>\n","protected":false},"author":2782,"featured_media":2161666,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_mo_disable_npp":"","fifu_image_url":"https:\/\/cndimages.nyc3.digitaloceanspaces.com\/breaking-news\/wp-content\/uploads\/2021\/01\/IMG_2758-scaled-1.jpg","fifu_image_alt":"","footnotes":""},"categories":[546],"tags":[],"class_list":["post-2161665","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-the-federalist"],"fifu_image_url":"https:\/\/cndimages.nyc3.digitaloceanspaces.com\/breaking-news\/wp-content\/uploads\/2021\/01\/IMG_2758-scaled-1.jpg","_links":{"self":[{"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/posts\/2161665","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/users\/2782"}],"replies":[{"embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/comments?post=2161665"}],"version-history":[{"count":0,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/posts\/2161665\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/media\/2161666"}],"wp:attachment":[{"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/media?parent=2161665"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/categories?post=2161665"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.conservativenewsdaily.net\/breaking-news\/wp-json\/wp\/v2\/tags?post=2161665"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}