Megan Byrne, interviewed below, graduated from the UC Davis School of Medicine in 2020 and is currently an intern in the Department of Internal Medicine at UC Davis Health. In 2020, Byrne and another medical student, Bisrat Woldemichael, challenged race-based reference ranges for the estimated glomerular filtration rate test, or eGFR. Byrne researched the test for a Race and Health course taught by Jann Murray-Garcia in winter 2020.
The test is routinely used to check how well a patient’s kidneys are functioning. Since about 1999, the eGFR has included a separate reference range for African American patients. In response to the students’ challenge, physicians at UC Davis Health formed a task force to evaluate changing the test. UC Davis Health eliminated race from the eGFR test on May 4, one of the first health systems in the nation to do so.
When did you first learn about the race correction for eGFR?
I worked at a clinic a few hours a week as an undergraduate, using EMR [electronic medical records] to track patients’ chronic diseases. The "African-American or not African-American" adjustment following creatinine is prominently displayed in the lab results section of any patient. I was immediately skeptical. The idea that a social construct (race), so oversimplified as this single binary variable, reliably tracking for overall renal function, did not fit my understanding of physiology and biology.
What inspired you to do your presentation on eGFR for Dr. Murray-Garcia’s class?
Dr. Murray-Garcia's class was the only opportunity I've had to apply rigorous evidence-based scientific practice to the topic of race, and through the view of healthcare professionals. It was a humbling and extremely valuable experience. The race correction for eGFR came quickly to my mind as a topic for my final presentation because it had nagged at me for years.
What was the key takeaway from your presentation?
Mostly I dug deeply into primary literature, looking for a truly evidence-based basis to assume that renal function is different between "African-American or not African-American" people in the first place. It seemed like the Chronic Kidney Disease Epidemiology Collaboration equation, CKD-EPI, used the adjustment just because the Modification of Diet in Renal Disease study equation had used it. Digging into MDRD, at least one of the papers was quite outdated and was trying to prove measurements that muscle mass differs between Black and white people. It did not have a clear rationale for studying this in the first place.
How does it make you feel to know that an issue you raised brought about the test change?
There has been a lot of momentum to change the race adjustment since 2020. I'm grateful to be practicing medicine in a time in which we are ready to take the first steps into examining inherent racism and bias within our field. There is so much work to be done to keep this momentum moving and cause meaningful change. I am also always grateful to be at UC Davis with many people who care about addressing health inequities.