Please join us on Friday, November 22nd for our Philosophy Department Colloquium with Professor Zinhle Mncube.
 
The event will start at 3:00 pm in Claudia Cohen Hall 402, with a reception to follow in the lounge.

 

What Does Your Race Tell Doctor's About Your Kidneys?

 

 

 

Abstract: 

 

There is a recent and growing body of literature against the use of race in specific risk prediction models to estimate kidney function via glomerular filtration rate (GFR). These are creatinine-based, estimated glomerular filtration rate equations referred to as ‘eGFRcr’. Accurate assessment of kidney function is important in clinical practice to inform the detection and diagnosis of renal disease, the staging of chronic kidney disease, the dosing of medications excreted renally, the referral of patients to specialists, and the evaluation of kidney transplant waitlists, amongst others.

 

Critics of race-inclusive eGFRcr equations defend a position I call ‘eliminativism’. Eliminativists argue that we ought to reject the use of race as a predictor in GFR assessment as it perpetuates systemic health inequities for Black patients in the U.S. Proponents of race-inclusive eGFRcr equations defend a position I call ‘conservationism’. Conservationists warn that removing race from GFR assessment would have predictively harmful consequences for Black patients because eGFRcr equations are more accurate estimates of kidney function than similar equations without race. Today, several medical institutions in the U.S. suggest the use of the eGFRcr equations without a race co-efficient.

 

In this talk, I propose a novel assessment of race-inclusive eGFRcr equations using the adequacy-for-purpose framework of model evaluation championed by some philosophers as a method of assessing scientific models. Rather than asking whether we should conserve or eliminate the use of race in eGFRcr equations, my analysis explores the question of how confident clinicians should be in the likelihood of race-inclusive eGFRcr equations accurately predicting the kidney function of individual patients in clinical practice to guide renal clinical care decisions. I argue that for various reasons, race-inclusive eGFRcr equations are inadequate for the purpose that clinicians are interested in.