August 21, 2025
This issue highlights recent position papers, consensus statements, and clinical practice tools that promote race-neutral approaches to risk assessment, diagnosis, or staging of certain chronic conditions. While the rationale and clinical implications for eliminating race-based variables vary across specialties, all publications emphasize that race is a social, rather than a biological, construct subject to inconsistent interpretation.
Although these guidelines, tools, and articles primarily address general adult populations, the principles they present are highly relevant to advancing equity in the care of older adults. We hope you find these readings informative and thought-provoking.
GUIDELINES AND TOOLS
Cardiovascular disease:
In November 2023, the American Heart Association (AHA) introduced the PREVENTTM online calculator to help improve risk assessment of overall cardiovascular disease (CVD), atherosclerotic cardiovascular disease (ASCVD), and heart failure (HF) in primary prevention patients. In contrast to the pooled cohort equations (PCE), PREVENTTM is race-free, adjusts for competing risk of non-cardiovascular death, and factors cardio-kidney-metabolic (CKM) markers into its risk prediction algorithm. A zip code-based social deprivation index (SDI) variable is also included to help refine estimations. The recently-published 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM guideline on hypertension management (developed in collaboration with AGS) recommends using the PREVENTTM tool in place of PCE to guide risk stratification and pharmacologic management decisions.
Chronic kidney disease:
The April 2024 Kidney Disease Improving Global Outcomes (KDIGO) guideline states that race should be avoided in the estimation of renal function via glomerular filtration rate (eGFR, practice point 1.2.4.2). It supports using validated eGFR equations like the 2021 CKD-EPI equations, which were refitted to be race-free. The guideline also addresses the role of cystatin c (cysC) in renal function estimations, outlining candidates for whom cysC collection may be useful (patients at extremes of body weight, with para- or quadriplegia, or with muscle wasting diseases). It touches briefly on the limitations of the Cockcroft-Gault estimated creatinine clearance (eCrCl) equation in assessing renal function for drug dosing purposes (practice point 4.2.3). In November 2024, a pharmacist-led NKF (National Kidney Foundation) Workgroup published a detailed consensus statement recommending a shift towards assessing and monitoring renal function using BSA-adjusted, race-free eGFR values. This article delves into the generalizability and standardization-related limitations of the Cockcroft-Gault equation, describes changes to FDA recommendations for drug studies, and offers guidance on the appropriateness of different renal function assessment approaches to ensure equitable medication management and care provision.
Pulmonary disease:
Pulmonary Function Testing: ATS Moves Toward Race-Neutral Standards: In February 2023, the American Thoracic Society (ATS) issued a statement recommending the replacement of race and ethnicity-specific reference equations with race-neutral average reference equations in the interpretation of pulmonary function tests (PFT). This shift reflects the understanding that race is a social, not biological, construct, and aims to improve diagnostic equity, clinical accuracy, and fair access to healthcare-related determinations such as disability certification and occupational eligibility.
The Global Lung Function Initiative (GLI) Global 2022 equation is now the preferred tool. It eliminates racial classification and performs well across diverse populations. ATS also calls for ongoing research and close monitoring of the real-world effects of this transition, particularly in underrepresented groups.
IN THE LITERATURE
Implications of Race-Neutral Lung Function Equations: A recent study compared the race-specific Global Lung Function Initiative 2012 (GLI-2012) equations with the race-neutral GLI-Global 2022. Results showed that eliminating racial adjustment did not reduce predictive accuracy for respiratory outcomes. However, it uncovers more cases of lung impairment with disease re-classification especially in Black populations, hence addressing historical underdiagnosis. The change could reshape transplant eligibility, disability benefits, and employment standards, requiring significant system-level adaptations and operational changes.
About the E-LeNS (Ethnogeriatrics Literature and News System) e-Newsletter
E-LeNS is a quarterly newsletter designed to provide AGS members with the latest news, resources, and insights on ethnogeriatrics across research, education, and clinical practice. Developed by the AGS Ethnogeriatrics Committee in collaboration with the Ethics Committees, E-LeNS aims to foster a deeper understanding of the diverse needs of older adults, focusing on socioeconomic, ethnocultural, and accessibility-related disparities, particularly among underserved and minoritized populations. By curating relevant content and encouraging open dialogue, our goal is to unite perspectives, advance practices across specialties, and improve equitable care for all of us as we age. This newsletter serves as a one-stop resource to enhance our collective knowledge and skills in providing high-quality, equitable care. If you have suggestions for future issues, please email: egallagher@americangeriatrics.org