The Quick Version
- Black adults develop kidney failure at about three times the rate of white adults, driven mostly by high blood pressure and diabetes rates, not biology alone.
- In 2021, the two major U.S. kidney organizations removed a race based adjustment from the standard eGFR blood test that had been making Black patients’ kidney function look healthier than it actually was.
- That change is still working its way through labs, so it is worth asking your doctor directly whether your eGFR result used the old formula or the new one.
- If you have diabetes, high blood pressure, or a family history of kidney disease, ask for two yearly tests: an eGFR blood test and a urine albumin test.
Kidney disease has a reputation for being silent, and for Black patients that silence has been made worse by a testing formula that, until recently, was built to underestimate how sick some patients actually were. About 37 million Americans live with chronic kidney disease, and Black adults make up a disproportionate share of the roughly 100,000 people who start dialysis or need a transplant each year. Understanding why, and what changed in how doctors test for it, matters for anyone managing diabetes, high blood pressure, or a family history of kidney problems.
Why Black Adults Carry a Heavier Kidney Disease Load
Black Americans are about three times more likely than white Americans to develop kidney failure, according to data tracked by the National Institute of Diabetes and Digestive and Kidney Diseases. The biggest drivers are the same conditions that show up across so much of Black health data: high blood pressure and type 2 diabetes, both of which damage the small blood vessels inside the kidneys over years, often without symptoms. A gene variant called APOL1, found more often in people with West African ancestry, is also linked to higher kidney disease risk. Carrying the variant does not mean kidney failure is inevitable, and research on APOL1 is still developing, so treat it as one piece of a bigger risk picture rather than a verdict.
The Test That Was Quietly Working Against Black Patients
For decades, the standard blood test for kidney function, called eGFR, used a formula that automatically adjusted results upward for anyone marked as Black in the medical record. The assumption behind that adjustment was that Black patients have more muscle mass on average, which affects a waste product called creatinine that the test measures. In practice, the adjustment often made kidney function look better than it was, which meant later diagnoses, delayed referrals to kidney specialists, and later spots on transplant waiting lists.
In 2021, the National Kidney Foundation and the American Society of Nephrology jointly recommended a new, race free eGFR formula. Major hospital systems and labs have been adopting it since, but the rollout has not been instant or uniform, and some smaller labs may still be catching up. That matters, because the number on your lab report depends partly on which formula your lab is using.
What Changed, and What Is Still Catching Up
If you have not had your kidney function checked recently, or if it has been a few years, it is reasonable to ask your doctor whether your last eGFR result reflects the updated, race free calculation. Patients who were told their kidney function was normal several years ago may be due for a fresh look, particularly if they also manage diabetes or high blood pressure.
What To Ask For At Your Next Appointment
Two tests, done together, give a much fuller picture than either one alone. The first is the eGFR blood test, which estimates how well your kidneys filter waste. The second is a urine albumin test, sometimes called a UACR, which checks for protein leaking into urine, often the earliest sign of kidney damage. Ask your doctor for both, especially if you are over 40, have diabetes, have high blood pressure, or have a parent or sibling with kidney disease. Kidney disease is staged from 1 to 5 based on these results, and catching it at stage 2 or 3 leaves far more room to slow it down through blood pressure control, diet changes, and medication than catching it at stage 4.
Where the Research Is Still Thin
Much of the clinical trial data behind kidney disease drugs, including newer medications that protect kidney function in people with diabetes, was built on study populations that underrepresented Black patients for years. That gap is closing, but it means some of the guidance your doctor is working from was tested on a population that did not fully reflect the patients most affected by the disease. It is a fair question to ask your care team directly, and a fair reason to seek a second opinion from a nephrologist if something about your treatment plan does not add up.
Your Next Step
If you are managing diabetes or high blood pressure, put an annual eGFR and urine albumin test on your calendar the same way you would a dental cleaning. The National Kidney Foundation runs free kidney health screenings in many cities and offers a helpline at 1.800.622.9010. The American Kidney Fund also provides financial assistance for patients already in treatment, reachable at 1.800.638.8299. Early detection is still the single biggest lever patients have, and now the test itself is finally measuring Black patients’ kidney function accurately.
