Social Determinants of Health and Their Impact on the Black Race Coefficient in Serum Creatinine–Based Estimation of GFR

Abstract

Visual Abstract

Retaining Race in Chronic Kidney Disease Diagnosis and Treatment

“…Annual per capita intake is slightly less in Blacks than Whites for both total meat (35.6 vs. 37.5 kg/person) and beef (20.2 vs. 22.1 kg/person) [ 141 ]. When adjusted for measured GFR, Blacks had higher serum creatinine concentrations despite lower protein intake than non-Blacks in the MDRD [ 142 ] and CRIC studies [ 3 , 142 ]. (Left unexplained is the higher estimated net acid excretion in Blacks than Whites [ 143 ], which could reflect higher animal protein intake in the former.)…”

“…Moreover, SES (i.e., deprivation) was also unrelated to serum creatinine levels in the UK Biobank multiracial study cohort [ 79 ]. Similarly, adjustment for social determinants of health did not substantially change the 16% and 10% higher mean creatinine concentrations in Blacks than non-Blacks in the MDRD and CIRC studies, respectively, when adjusted to the same mGFR [ 142 ], nor the 21% higher mGFR in Blacks than non-Blacks in the MDRD study nor the 13% higher mGFR in the CRIC when adjusted to the same serum creatinine concentration [ 142 ].…”

Social Determinants of Health and Estimation of Kidney Function

“…4 In the United States, discriminatory policies have created marked inequities in the social environment, as evidenced by racially and economically segregated communities; differential access to high-quality schools, nutritious food, and safe housing; and marked variation in neighborhood walkability, availability of green spaces, and exposure to environmental pollutants. 4 In this issue of CJASN, Eneanya et al 5 apply a social determinants framework to investigate the influence of selected sociodemographic factorsindividual-level educational attainment, employment status, marital status, and annual household incomeon the performance of serum creatinine-based GFRestimating equations. The investigators re-examined data from the MDRD and CRIC studies to test whether measured sociodemographic factors and nonglomerular determinants of creatinine could account for differences in serum creatinine-based GFR estimates previously attributed to Black race.…”

“….may reflect the effects of systemic racism and discrimination on health." 5 Racismorganized systems within our society that result in avoidable, unequal distribution of power, resources, and opportunities on the basis of race-frequently affects health through social conditions. Although the relative contributions may vary, studies overwhelmingly find that social determinants collectively and consistently contribute far more to health and health outcomes than medical care.…”

“…In looking forward, the study by Eneanya et al necessitates a more inclusive and systematic approach to incorporating social determinants of health into nephrology research and clinical practice. As the investigators note, a “wider array of factors…may reflect the effects of systemic racism and discrimination on health.” 5 Racism—organized systems within our society that result in avoidable, unequal distribution of power, resources, and opportunities on the basis of race—frequently affects health through social conditions. Although the relative contributions may vary, studies overwhelmingly find that social determinants collectively and consistently contribute far more to health and health outcomes than medical care.…”