LAUSR

A 72-year-old Black woman was seen in the general nephrology clinic at a large academic center. She had a 10-year history of CKD secondary to diabetes mellitus type II and hypertension. Her medical history was also notable for hyperlipidemia, obstructive sleep apnea, and diabetic retinopathy. As of October 2020, her CKD-EPI eGFR adjusted for Black race was 20 mL/min/1.73m, which met the criteria for transplant referral. Twelve months prior to her CKD-EPI eGFR, SCr adjusted for Black race was 23 mL/min/1.73m (non-Black eGFR = 20). During that time, she had continued consulting with her nephrologist, receiving an eGFR assessment every 2– 4 months that showed steady decline in eGFR (Table 1). Due to the reliance on race-adjusted eGFR in CKD-EPI, her referral to the kidney transplant clinic for an initial evaluation was delayed by approximately 12 months. Had she not been identified as Black, this delay would not have occurred. When her nephrologist explained the connection between the timing of the referral and the binary use of race in GFR estimating equations, she was visibly disappointed. She was referred to vascular surgery for placement of arteriovenous fistula for dialysis preparation, partly due to concern that waitlist times would necessitate dialysis as a bridge to a kidney transplant.