Over my 30 years as a primary care physician, I've grown accustomed to reviewing the chemistry panel with my patients, many of whom want to understand their laboratory findings and like to keep copies of the test results. But as an African American physician with a multiethnic practice, I know that trouble is coming when we reach the part of this panel that reports kidney function. Beneath the creatinine results is the now-familiar GFR estimate, with the instruction to multiply this number by 1.21 if the patient is African American. And this is where my headaches begin. My Asian and Latino patients see the modification for African Americans and ask, "What about me?" They worry that they have been left out of the equation. My African American patients ask, "Why is it different for African Americans?" They are not entirely happy that the modification of the estimate makes their kidney function look better. Many of them know that African Americans have a higher risk of developing chronic kidney disease than whites do. They may have friends or family who had kidney failure. They have seen the articles on disparities between whites and African Americans when it comes to various aspects of kidney disease care, from preventive management to access to transplantation. They worry that the value for non-African Americans is the "real" number and that the value for African Americans is increased so that intervention will be delayed. The suspicion in their tone is born of years of experience with separate and unequal.
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