Removing race eGFR estimates may impact care of Black patients with cancer

Aug. 18, 2021

In a paper published in The Lancet Oncology, researchers at University of Pittsburgh Schools of the Health Sciences found that removing race-based adjustments from equations estimating the kidney function of oncology patients may negatively impact care for Black patients with cancer, according to a news release from UPMC.

The analysis showed that removal of race from these calculations —proposed by prominent health organizations — would make many Black people ineligible for cancer treatments and may prompt oncologists to give Black patients a lower dose of anti-cancer medications than clinically needed.

The statistics are sobering: Black patients in the United States are more frequently diagnosed with cancer and are more likely to die from it than White Americans. The researchers argue that because Black Americans are already more likely to be undertreated, an optimal dose of anti-cancer drugs often makes a difference between life and death — and that, until practical alternatives become available, race remains a factor that should not be ignored in considerations of dosages for cancer treatments.

To quickly assess kidney function in a way that doesn’t require invasive procedures, clinicians use a mathematical equation that correlates the creatinine concentration in the blood with the rate of creatinine excretion by the kidneys, resulting in a parameter called estimated glomerular filtration rate, or eGFR. The equations used to calculate eGFR may be used to estimate kidney function in oncology patients — and dictate their eligibility for anti-cancer drugs.

One equation commonly used to calculate eGFR, known as the CKD-EPI equation, includes adjustments for the patient’s age and sex. In addition, the CKD-EPI equation includes a factor to adjust for race that multiplies the kidney function estimate by 1.16 if a patient self-identifies as Black.

Recently, a joint task force established by the National Kidney Foundation (NKF) and the American Society of Nephrology (ASN) proposed replacing eGFR equations that include race with alternative equations that do not propagate the misconception of race as a biological determinant of health and disease.

To determine whether taking race into account in kidney function calculations might benefit or harm Black cancer patients, the researchers combed through 15 years of data collected as part of early clinical trials conducted by the National Cancer Institute.

The analysis showed that Black patients would be deemed ineligible to receive anti-cancer drugs or recommended to get lower doses more frequently if the race term wasn’t included. The number of Black people ineligible to receive a widely used chemotherapy medication called cisplatin increased by 72% if race wasn’t considered. For another chemotherapy drug called bleomycin, that number went up 163%.

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