If a person self-identifies as Black, the equation adjusts their score, increasing it. No other races are counted in the equation. As a result, Black people have higher eGFR scores than people of other races. Those scores, which estimate how well kidneys are functioning, influence doctors’ treatment recommendations. The lower the score, the more likely a patient is to begin dialysis or even to receive a kidney transplant. 

As the disparities facing Black people with kidney disease became more widely studied, the race-based eGFR has been increasingly challenged by nephrologists, high-profile kidney disease organizations, and, crucially, medical students who questioned their educators about the biological basis for differentiating between Black and non-Black people.

Warfield has been advocating for other people with kidney disease since he received a transplant in 2015. He joined a multi-organization task force spearheaded by the National Kidney Foundation in 2020. The task force spent months diving into the issue, challenging the inclusion of race in the eGFR, and ultimately initiated two new equations for estimating kidney function.

Those disparities were the basis of increased questions from medical students over the past several years, Mehrotra said, particularly when it came to the equation the students were learning to assess kidney function.

“They were told in the class that there’s an equation in which it reports a different number if you’re Black versus if you’re not Black. And they challenged the premise of that, as in like, ‘What is the evidence that there is a difference there?’’ Mehrotra said. “And so the deeper we dug in terms of searching for the evidence to support a differentiated reporting by race, we came to the assessment that the evidence supporting that is not strong at all.”

University of Washington Medicine, where Mehrotra works, became one of the first institutions to do away with the race variable of the eGFR equation back in June 2020.

In June 2021, a year after Washington Medicine dropped the racialized eGFR, the task force formed by those organizations released an interim report questioning the use of race as a factor in diagnosing kidney care.

The race variable in the eGFR had come about based on research from the 1990s, according to the report. Published in 1999, the Modification of Diet in Renal Disease (MDRD) study was one of the first to include Black people – an earlier kidney function estimation equation was based entirely on white, male patients’ information – and it found higher levels of serum creatinine among Black adults than their white counterparts, the task force authors write in their report.

At the time of the MDRD, making a mathematical adjustment based on race was seen as an advance because including Black people in studies at all was an advance, according to the report.

But within the MDRD is a troubling justification for higher creatinine levels among Black people: earlier studies had shown that “on average, black persons have greater muscle mass than white persons.” The three studies cited there, published in 1977, 1978 and 1990, compared different health measures, including serum creatinine kinase and total-body potassium levels, in Black and white study participants. The studies all state that separate reference standards are needed for Black people, attributing differences in results to differences in racial biology.

Today, those conclusions would be challenged.

“Our understanding of race has evolved over the last quarter century,” said Paul Palevsky, MD, the president of the National Kidney Foundation and a professor at the University of Pittsburgh, one of the primary organizations in the task force. “Rather than being biologically based, race is much more of a social construct than anything else.”

“In medicine, the time that it normally takes from when a clinical practice guideline or recommendation is published to when it really seems to enter into clinical care is about a decade,” Palevsky said. “In this case, what we’re seeing is a very rapid implementation of the new equation.”

The new equations are slightly less precise compared with the old equation, Palevsky and Mehrotra agree. But the estimates are just that – estimates – and should be used as just one part of a much more comprehensive clinical analysis of a person’s health and needs.

And as racial disparities across medicine continue to be studied and understood, the impacts of factoring in race in health care decisions can have a corrosive effect beyond an individual person and their diagnosis, Palevksy said. “As we teach medical students and residents, if we use race-based algorithms, we are reinforcing for them this concept, this false concept, that race is a biological determinant of disease, which it is not,” Palevsky said.

Systemic racism factors into Black people’s health outcomes in many different ways, from chronic stress of experiencing racism to limited access to healthy food to bias of health care providers. These problems are deeply entrenched and require their own sustained solutions.

The new eGFR equation, though, is a step in the right direction, Palevsky said.

“There are also different interpretations of dietary patterns, such as what ‘keto’ means to one person may mean something else to another person,” said Debbie Fetter, PhD, assistant professor of teaching in the department of nutrition at the University of California, Davis. “There are many forms of vegetarianism as well. This may mean respondents could classify their dietary patterns differently, which affects the results.”

Instead of focusing on a specific diet, aim for 7 to 9 hours of sleep per night, Fetter said, noting that more than a quarter of American adults don’t meet this goal. Also, start incorporating more plants into your diet, she suggested. A whopping 90% of American adults do not get the recommended 2 cups of fruit and 2.5 cups of vegetables per day.

“Sleep deprivation can have a negative impact on cognitive function, which may lead to impaired decision-making and influence health. For example, if someone is low on sleep, they may choose more energy-dense comfort foods instead of a nutrient-dense option, or they could feel too tired to engage in physical activity,” Fetter said.

“For instance, based on this survey, people who consumed cereal reported having the worst sleep quality — but we don’t know about these people’s lifestyles, sleep conditions, dietary or physical activity habits, socioeconomic status, stress level, and more that can all have an impact on their sleep. It may not be because of the cereal,” Fetter said. 

Insomnia was the most common sleep disturbance among respondents in the survey. If you are having trouble falling asleep, here are a few things you can try: Skip spicy meals before bedtime, as it can lead to heartburn. Have a scheduled bedtime and wake-up time and stop drinking caffeine 6 to 8 hours before bed. Creating a wind-down routine — such as reading a book, journaling, or coloring in an adult coloring book — can also promote good sleep hygiene, according to Fetter. You could also try  a “sleepy girl mocktail,” a viral trend that is a nonalcoholic concoction of sparkling water, tart cherry juice, and a magnesium supplement.