Intended for healthcare professionals


NICE takes ethnicity out of estimating kidney function

BMJ 2021; 374 doi: (Published 10 September 2021) Cite this as: BMJ 2021;374:n2159

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Chronic kidney disease: summary of updated NICE guidance

  1. Rouvick M Gama, nephrology registrar1,
  2. Robert Kalyesubula, consultant nephrologist2 3,
  3. June Fabian, nephrology researcher4,
  4. Viyaasan Mahalingasivam, research fellow35
  1. 1King’s Kidney Care, King’s College Hospital NHS Trust, London, UK
  2. 2Makerere University College of Health Sciences, Kampala, Uganda
  3. 3Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
  4. 4Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
  5. 5Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, UK
  6. Correspondence to: R M Gama

A welcome step with the potential to reduce health inequalities

The updated guidelines on chronic kidney disease from the National Institute for Health and Care Excellence (NICE), published on 25 August 2021, have recommended discontinuing adjustment for ethnicity when calculating estimated glomerular filtration rate (eGFR) in people from black ethnic groups.1 This change has been strongly supported by the UK Kidney Association and partner organisations,2 on the grounds that it further exacerbates health inequalities by overestimating kidney function in these groups.

Recent campaigns raising awareness of the socioeconomic and ethnic determinants of health inequalities globally have brought the detrimental effect of adjusting for ethnicity or race to the fore and called into question its validity.3 Both race and ethnicity are social constructs and therefore assumptions about biological differences are inappropriate; while genetic, socioeconomic, and environmental factors all plausibly contribute to differences between individuals, the broad categorisation of people into “black” and “non-black” for the purposes of quantifying kidney function fails to recognise the extensive heterogeneity that exists within all ethnic groups.

Around 10% of adults globally have chronic …

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