ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on X

Kidney Week

Please note that you are viewing an archived section from 2022 and some content may be unavailable. To unlock all content for 2022, please visit the archives.

Abstract: TH-PO730

Patients' Perspectives on Race and the Use of Race-Based Algorithms in Clinical Decision-Making: A Qualitative Study

Session Information

Category: Diversity and Equity in Kidney Health

  • 800 Diversity and Equity in Kidney Health


  • Schmidt, Insa Marie, Boston University School of Medicine, Boston, Massachusetts, United States
  • Shohet, Merav, Boston University College of Arts and Sciences, Boston, Massachusetts, United States
  • Serrano, Mariana, Massachusetts Department of Public Health, Boston, Massachusetts, United States
  • Yadati, Pranav, Boston University School of Medicine, Boston, Massachusetts, United States
  • Menn-Josephy, Hanni, Boston University School of Medicine, Boston, Massachusetts, United States
  • Eneanya, Nwamaka D., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Cleveland Manchanda, Emily C. C., Boston University School of Medicine, Boston, Massachusetts, United States
  • Waikar, Sushrut S., Boston University School of Medicine, Boston, Massachusetts, United States

Clinical algorithms that incorporate race as a modifying factor to guide clinical decision-making have recently been criticized for propagating racial bias in medicine. The calculation of kidney function is an example of a clinical equation that has different diagnostic parameters depending on an individual’s race (Black vs. non-Black). While this clinical measure has multiple implications for clinical care, patients’ awareness of and their perspectives on the application of such algorithms is not known.


This qualitative study included 23 adult participants who were recruited from Nephrology Clinics at a safety-net hospital in Boston, Massachusetts. We conducted individual semi-structured interviews to examine patients’ perspectives on race and the use of race-based algorithms in clinical decision-making. Interviews were audiotaped, transcribed, and analyzed using thematic content analysis and modified grounded theory.


Among the 23 study participants, 11 (48%) were women and 15 (65%) self-identified as Black or African American. Three categories of themes emerged: The first theme described definitions and the individual meanings participants ascribed to the term race. The second theme described perspectives on the role and consideration of race in clinical decision-making. Most study participants were unaware that race has been used as a modifying factor in clinical equations and rejected the incorporation of race in these equations. The third theme related to exposure to and experience of racism in healthcare settings. Experiences described by non-white participants ranged from microaggressions to overt acts of racism, including perceived racist encounters with healthcare providers. In addition, patients alluded to a deep mistrust in the healthcare system as a major barrier to equitable care.


Findings from this study suggest that most patients are unaware of how race has been used to make risk assessments and guide clinical care. Further research on patients’ perspectives is needed to inform the development of anti-racist policies and regulatory agendas as we move forward to combat systemic racism in medicine.