UCSF Leads Effort to Improve Racial Equity in Kidney Medicine

As medical institutions around the country intensify efforts to eliminate structural racism from their systems and practices, UC San Francisco faculty have been at the forefront of this pursuit in kidney medicine.

In late September, a task force co-chaired by UCSF faculty released eagerly awaited recommendations to remove a race modifier from an equation that estimates kidney function. Those recommendations incorporated research by other UCSF faculty into how best to calculate kidney function without using race. The movement for race-free medicine, in nephrology and beyond, was spurred by activism from medical students, residents and faculty at UCSF and other institutions. It also helped inspire UCSF Health to remove race in estimates of kidney function.

“I give a lot of credit to the activists who pushed us and who don’t always get the academic recognition. They stimulated thinking in a way that was very valuable,” said Chi-yuan Hsu, MD, professor of medicine and chief of the Division of Nephrology at UCSF Health, whose research on a new approach using cystatin C to estimate kidney function without race was published last week in the New England Journal of Medicine. “And the task force, of course. They took a lot of heat and didn’t have an easy job. Their recommendations are well-considered and reasonable.”

Race and eGFR

At issue is an algorithm for estimated glomerular filtration rate, or eGFR, which is used to diagnose and capture the severity of chronic kidney disease. Since 1999, the most common eGFR equations used blood creatinine levels, sex, age – and Black or non-Black race. That’s because studies found creatinine levels were higher in people who self-reported as Black, even when their actual measured kidney function was the same as non-Black persons with lower creatinine levels.

For many people, an adjustment for Black persons perpetuates harmful notions that race is a biological construct instead of a social one, said Neil Powe, MD, Constance B. Wofsy Distinguished Professor and Vice Chair of Medicine at UCSF and Chief of Medicine at the Priscilla Chan and Mark Zuckerberg San Francisco General Hospital. Powe co-chaired the