Reconsidering the consequences of using race to estimate kidney function

Clinicians estimate kidney function to guide important medical decisions across a wide range of settings, including assessing the safety of radiology studies, choosing chemotherapy, and reviewing the use of common nonprescription medications such as nonsteroidal anti-inflammatory drugs. Because direct measurement of kidney function is infeasible at the bedside, the usual approach involves using estimating equations that rely on serum creatinine. These equations assign a higher estimated glomerular filtration rate (eGFR) to patients who are identified as black. Yet in some medical and social science disciplines, a consensus has emerged that race is a social construct rather than a biological one. In this Viewpoint, we argue that the use of kidney function estimating equations that include race as a variable cause problems for transparency and unduly restrict access to care in some cases, yet offer only modest benefits to precision.