M Health Fairview to end breed as determinant of kidney health
M Health Fairview will no longer use breed as an automatic fit to determine kidney health, following recommendations from a task force of its doctors convened last summer.
For decades, healthcare providers nationwide have automatically adjusted a measure of kidney health (estimated glomerular filtration rate (eGFR)) based on the patient’s race. Black patients had one set of guidelines, non-Black patients had another.
Based on the mistaken assumption that race is biological, the adjustment may make black patients’ kidneys appear healthier than they actually are. This can cause delays in both getting advanced care and being registered for a kidney transplant, if needed. M Health Fairview will no longer use race as an automatic adjustment when determining eGFR.
âWhen we evaluated the effect of this practice on patient care, we found it problematic at best,â said Kristina Krohn, MD, hospital attendant at M Health Fairview. Krohn, who is also an assistant professor in the Department of Medicine at the University of Minnesota School of Medicine, chaired the task force. âAs we find a better way, we need to stop doing what we know is wrong. “
Leading healthcare organizations across the country are starting to reassess such calculations, in part thanks to the grassroots efforts of scientists, vendors, medical students and the national race for racial justice movement.
âMedicine must consider its role in the process of justifying exploitation and oppression,â said Brooke Cunningham, MD, Ph.D., internist at M Health Fairview. Cunningham was a member of the eGFR Working Group and is an Assistant Professor in the Department of Family Medicine and Community Health, University of Minnesota School of Medicine. âWe have to interrupt this legacy, and one way to do that is to question the ideas that underpin these calculators and algorithms. If the origin of the calculator is based on a biological construct of race, we have to change it.
Doctors at M Health Fairview formed their task force in June 2020 and ultimately recommended removing the breed-based adjustment. Around the same time last summer, the healthcare system took another important step toward eliminating structural racism in healthcare – creating the Commission on Healing, Opportunity, People and Equity ( HOPE). The HOPE Commission guidelines inform the decisions of M Health Fairview, and the removal of the automatic adjustment of the eGFR is one example.
âM Health Fairview takes a critical look at how it works both at very granular levels, like this one, and at broader levels,â said internist and pediatrician Taj Mustapha, MD, a member of the eGFR working group and M Health Fairview. HOPE Commission. Mustapha is also an Assistant Professor in the Departments of Medicine and Pediatrics at the University of Minnesota School of Medicine.
âAccounting for the inequalities and misconceptions that are embedded in healthcare and medicine will take time and work, and this is just one example of this work happening across the company. “
The removal of the race-based eGFR adjustment will take effect at M Health Fairview in July.