Published December 12, 2024
A common lab test for kidney function has been in the spotlight lately.
The test itself – estimating glomerular filtration rate (eGFR) – isn’t the issue. It’s how the test is calculated and how results are interpreted in some cases that are attracting attention.
In 2022, Yale New Haven Health (YNHHS) and Yale School of Medicine (YSM) clinicians joined colleagues nationwide in changing the way they evaluate eGFR results because the standard approach was found to be inaccurate and racially biased.
This past year, YNHHS and YSM investigators focused on how gender identities affect eGFR testing and reporting.
They found that Epic required clinical labs calculating the test results to identify patients as “male” or “female.” There were no options to indicate transgender patients – whose gender identity differs from the sex they were assigned at birth – and gender-diverse and non-binary patients – who identify with a gender or genders outside of male or female.
Without a “male” or “female” designation, the eGFR equation wouldn’t generate results. This wasn’t new, but to increase transparency, YNHHS in July 2023 began including a statement in transgender and gender-diverse patients’ medical records about why they didn’t have eGFR results. The Patient Experience office began receiving complaints from patients.
Another concern was how not reporting eGFR results impacted care. For example, some imaging procedures require the test to determine whether contrast material could increase patients’ kidney damage risk.
“Radiology and the Laboratory clinical directors began hearing about the difficulty in caring for transgender or gender-diverse patients, given the need to make decisions based on eGFR,” said Lou Hart, MD, medical director of Health Equity, YNHHS, and assistant professor of Pediatrics, YSM.
YNHHS and YSM healthcare professionals and transgender and gender-diverse advocates researched best practices and developed optimizations in Epic and the Care Signature Clinical Pathways that guide patient care. When an eGFR is ordered for transgender and gender-diverse patients, Epic now displays both “eGFR male” and “eGFR female” test results.
“This custom Epic build allows clinicians to review eGFR results for all patients, regardless of gender,” said Jessica McLaughlin, ITS laboratory application team lead, Digital and Technology Solutions, YNHHS.
“Not reporting eGFR for non-binary patients could delay critical care,” said Nancy Kim, MD, PhD, senior medical director, Care Signature, YNHHS, and associate clinical professor, General Internal Medicine, YSM. “Reporting eGFR for both male and female reference ranges ensures that non-binary patients receive timely and effective treatment based on their physiological needs, not on outdated assumptions.”
Guidelines on how to best use the two results in patient care are in development.
While the eGFR gender issue is being resolved, it has raised questions about other clinical processes requiring a “male” or “female” designation in Epic, Dr. Hart said.
This is one of many questions YNHHS and YSM, along with organizations nationwide, are exploring as part of their work to eliminate healthcare disparities that can lead to differences in treatment and outcomes based on patients’ race, ethnicity, gender, socioeconomic status and other factors. Watch for more information about YNHHS and YSM health equity efforts.
