Becker's Clinical Quality & Infection Control

52 QUALITY IMPROVEMENT & MEASUREMENT Minneapolis health system eliminates race-based kidney health determinant By Erica Carbajal M inneapolis-based M Health Fairview will stop automatically adjusting for race in a formula commonly used to measure kid- ney function, the health system said March 16. e estimated glomerular filtration rate, or eGFR, was developed more than 20 years ago to help clini- cians evaluate kidney health. e equation uses cre- atinine — a waste product produced by the muscles and filtered out by the kidneys — and a number of other factors to estimate a person's kidney function. At the time it was developed, researchers were trying to understand everything that makes a difference in kidney function and included age, sex and race in the caclulation. "And they didn't necessarily think about 'Why does race make a difference?'" said Kristina Krohn, MD, hospitalist at M Health Fairview and chair of the task force that decided to end the practice of using race as a component in the eGFR equation. "e assump- tion was that it was muscle net difference, but the studies of muscle mass difference were actually not very good and pretty racist. As we get to the point where we're evaluating our use of race, we can't say why it's in the equation in the first place. at gets to be problematic," Dr. Krohn told Becker's. e formula is based on the incorrect assumption that race is biological and can overestimate Black patients' kidney health. "So, it can be later in the disease course that some- one gets recommended to see a nephrologist," Dr. Krohn said. "It can be later in the disease course that someone is listed for a transplant. We know that African Americans have a faster progression of kid- ney disease, but this also prevents us from picking it up early. Rather than helping us to decrease racial disparities, it seems to perpetuate them." Effective in July, M Health Fairview will no longer use race in the eGFR equation. In recent years, a number of other hospitals, including Boston-based Beth Israel Deaconess Medical Center, have moved to eliminate the use of race in the formula. Hospitals and health systems have taken it upon themselves to reconsider the use of race as a kidney health determinant while they await a national rec- ommendation from the National Kidney Foundation and the American Society of Nephrology. n Remdesivir linked to quicker clinical improvement in COVID-19 patients By Mackenzie Bean H ospitalized COVID-19 patients treated with remdesivir at Balti- more-based Johns Hopkins Medicine demonstrated faster clin- ical improvement than patients who did not receive the drug, according to a study published March 24 in JAMA Network Open. Researchers analyzed data on 2,438 patients with COVID-19 who were hospitalized across the system's five hospitals between March 4, 2020, and Aug. 29, 2020. Of these patients, 184 received remdesivir and cor- ticosteroids, and 158 received remdesivir alone. About 80 percent of patients who received remdesivir were not white. The median time to clinical improvement for remdesivir recipients was five days, compared to seven days for matched control patients. Patients treated with remdesivir had a 7.7 percent 28-day mortality rate. The control group had a 14 percent mortality rate, though this dif- ference was not statistically significant when researchers performed a time-to-death analysis. Adding corticosteroids to a patient's treatment regimen was not linked to reduced mortality. "These results provide further evidence that remdesivir may be effec- tive in reducing the duration of COVID-19 illness, that a [five]-day treat- ment course may be sufficient, and that patients with milder disease likely benefit most," study authors said. "The inclusion of a larger pro- portion of patients from underrepresented minority groups provides much-needed evidence suggesting the effectiveness of remdesivir administration in these groups." n In-hospital COVID-19 death rate fell significantly last year, study finds By Mackenzie Bean I n-hospital mortality for COVID-19 patients fell 15 percentage points from March to August 2020, according to a study published in JAMA Network Open. Researchers analyzed data on 192,550 adults hospitalized with COVID-19 at 555 hospitals from March to August 2020. Data came from the Vizient clinical database, which includes information on more than 650 academic medical centers in 47 states. Overall, 13.6 percent of patients included in the analysis died during hospitalization. In-hospital mortality fell significantly, from 22.1 percent in March, to 6.5 percent in August. The biggest drop occurred from April to May, when mortality fell from 18.1 percent to 12 percent. Researchers also found an association between increasing age and higher death rates. The study did not assess how treatment differences may have influ- enced mortality, which is a limitation, the researchers said. n

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