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Taking Racism Out of the Kidney Disease Equation




The first sign something was wrong with Curtis Warfield came in 2005, when a lab test found protein in his urine during a routine checkup. In 2012, Warfield was diagnosed with stage 3 kidney disease. Two years later, he started dialysis.

“When you get diagnosed, you’re sitting there kind of like a deer in headlights. You don’t know what’s going on. You don’t know what’s coming next,” Warfield said. “All you know, you have this disease.”

Warfield, a Black man, was 52 years old, had been healthy, and had no family history of kidney disease. As his condition worsened and he worked his way through treatment options, he experienced a form of racism without knowing it: a math equation that counted his race when it estimated his kidney function.

That equation, called the estimated glomerular filtration rate or eGFR, is an important variable that helps dictate the course of treatment for an estimated 37 million people with kidney disease across the country. The eGFR equation estimates how well a person’s kidneys are filtering blood, taking into account a person’s age, gender, and levels of creatinine, a waste product naturally made by people’s bodies that is cleared out through the kidneys. But it has long involved a controversial variable: race.

If a person self-identifies as Black, the equation adjusts their score, increasing it. No other races are counted in the equation. As a result, Black people have higher eGFR scores than people of other races. Those scores, which estimate how well kidneys are functioning, influence doctors’ treatment recommendations. The lower the score, the more likely a patient is to begin dialysis or even to receive a kidney transplant.

As the disparities facing Black people with kidney disease became more widely studied, the race-based eGFR has been increasingly challenged by nephrologists, high-profile kidney disease organizations, and, crucially, medical students who questioned their educators about the biological basis for differentiating between Black and non-Black people.

Warfield has been advocating for other people with kidney disease since he received a transplant in 2015. He joined a multi-organization task force spearheaded by the National Kidney Foundation in 2020. The task force spent months diving into the issue, challenging the inclusion of race in the eGFR, and ultimately initiated two new equations for estimating kidney function.

The new, race-neutral equations came out this past fall. And in February, the United Network for Organ Sharing (UNOS), the nonprofit organization that manages the organ donation and transplant system in the U.S., proposed dropping the use of the racialized eGFR in favor of a race-neutral eGFR. As a result, kidney care in the U.S. is at a watershed moment of moving past a deeply entrenched, institutionally racist equation.

Dropping the race factor from kidney estimations is a crucial step in reducing disparities in kidney disease and treatment, according to specialists on the National Kidney Foundation’s task force. Black Americans are at a disproportionate risk for conditions that contribute to kidney disease, like high blood pressure, diabetes, and heart disease. While Black people make up less than 14% of the population in the U.S., they encompass 35% of people on dialysis, according to the National Kidney Foundation.

“People that are Black are much less likely to be referred to transplant even when they are on dialysis. When referred, they’re much less likely to be listed. When listed, they’re much less likely to be given a kidney transplant. There are disparities every step of the way,” said Rajnish Mehrotra, MD, chief of nephrology at Harborview Medical Center and a University of Washington professor of nephrology and medicine.

Those disparities were the basis of increased questions from medical students over the past several years, Mehrotra said, particularly when it came to the equation the students were learning to assess kidney function.

“They were told in the class that there’s an equation in which it reports a different number if you’re Black versus if you’re not Black. And they challenged the premise of that, as in like, ‘What is the evidence that there is a difference there?” Mehrotra said. “And so the deeper we dug in terms of searching for the evidence to support a differentiated reporting by race, we came to the assessment that the evidence supporting that is not strong at all.”

University of Washington Medicine, where Mehrotra works, became one of the first institutions to do away with the race variable of the eGFR equation back in June 2020.

But there was a broader movement going on as well, involving the premier professional societies for kidney specialists, the National Kidney Foundation and the American Society of Nephrology, as well as patient advocates (including Warfield), clinicians, scientists, and laboratory technicians, all convening with the goal of phasing out the racialized eGFR in favor of a race-neutral approach.

In June 2021, a year after Washington Medicine dropped the racialized eGFR, the task force formed by those organizations released an interim report questioning the use of race as a factor in diagnosing kidney care.

The race variable in the eGFR had come about based on research from the 1990s, according to the report. Published in 1999, the Modification of Diet in Renal Disease (MDRD) study was one of the first to include Black people – an earlier kidney function estimation equation was based entirely on white, male patients’ information – and it found higher levels of serum creatinine among Black adults than their white counterparts, the task force authors write in their report.

At the time of the MDRD, making a mathematical adjustment based on race was seen as an advance because including Black people in studies at all was an advance, according to the report.

But within the MDRD is a troubling justification for higher creatinine levels among Black people: earlier studies had shown that “on average, black persons have greater muscle mass than white persons.” The three studies cited there, published in 1977, 1978 and 1990, compared different health measures, including serum creatinine kinase and total-body potassium levels, in Black and white study participants. The studies all state that separate reference standards are needed for Black people, attributing differences in results to differences in racial biology.

Today, those conclusions would be challenged.

“Our understanding of race has evolved over the last quarter century,” said Paul Palevsky, MD, the president of the National Kidney Foundation and a professor at the University of Pittsburgh, one of the primary organizations in the task force. “Rather than being biologically based, race is much more of a social construct than anything else.”

In September 2021, the task force released their two new equations that estimate kidney function. Neither uses race as a factor. One is very similar to the racialized eGFR, which measures creatinine. The other equation adds a second test that measures cystatin C, another chemical in the blood that serves as a filtration marker.

Both equations have been recommended because even though creatinine testing is available at virtually all laboratories across the country, cystatin C is not, leading to a higher price tag and decreased access to the test. The process to move laboratory practices toward the new standard is underway, said Palevsky, and he’s hopeful that the major labs will make the change over the next several months.

“In medicine, the time that it normally takes from when a clinical practice guideline or recommendation is published to when it really seems to enter into clinical care is about a decade,” Palevsky said. “In this case, what we’re seeing is a very rapid implementation of the new equation.”

The new equations are slightly less precise compared with the old equation, Palevsky and Mehrotra agree. But the estimates are just that – estimates – and should be used as just one part of a much more comprehensive clinical analysis of a person’s health and needs.

And as racial disparities across medicine continue to be studied and understood, the impacts of factoring in race in health care decisions can have a corrosive effect beyond an individual person and their diagnosis, Palevksy said. “As we teach medical students and residents, if we use race-based algorithms, we are reinforcing for them this concept, this false concept, that race is a biological determinant of disease, which it is not,” Palevsky said.

Systemic racism factors into Black people’s health outcomes in many different ways, from chronic stress of experiencing racism to limited access to healthy food to bias of health care providers. These problems are deeply entrenched and require their own sustained solutions.

The new eGFR equation, though, is a step in the right direction, Palevsky said.

“Will it solve the problem of disparities in kidney care? I think we would be deluding ourselves to think that a simple change in an equation is going to solve much, much deeper-rooted problems,” Palevsky said. “Certainly just changing an equation isn’t going to solve the problems of disparities, many of which are rooted in historic racism.”

Those disparities will only be meaningfully lessened by large-scale investment into the health of poor communities. But the eGFR equation is a meaningful step for Black people with kidney disease, nonetheless. The benefits of the new eGFR equation, Warfield said, expand beyond the equation itself.

“It’s opening eyes and doors to other disparities that are going on, at least within the kidney community, and getting people to talk about and look at what all is going on,” Warfield said. “It’s good to have to know that the patient’s voice is now sitting at the table and being listened to, and not just decided by the medical community.”

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Study: Marijuana Increases Risk of Premature Heart Attacks, Small Molecule in Soy Could Mitigate Risk




How does cannabis impact our health? 

Although an old question, the answer is not a simple one. Marijuana is a specific plant with many compounds that differently impact our bodies and minds. What makes things even more complicated is the lack of cannabis research, thanks to the decades-old war on drugs. 

Thankfully, with the ongoing momentum to legalize marijuana, more and more research is being conducted, providing consumers and the canna-curious with various results on the effects of consumption. Some are positive, some are not. 

One of the newest studies, led by researchers at Stanford Medicine revealed that individuals who consume marijuana have a higher risk of heart disease and heart attack. 

According to the study, THC or the psychoactive component of marijuana causes inflammation in endothelial cells that line the interior of blood vessels, reported Stanford Medicine. Furthermore, the compound known to stimulate the often yearned for sensation of being high can lead to atherosclerosis or the buildup of fats in artery walls in laboratory mice. 

Researchers also discovered that a small molecule called genistein, naturally found in soy and fava …

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InMed Pharmaceuticals Is Commercializing the Development of Rare Cannabinoids for the Wellness Market




Upon its acquisition of BayMedica LLC last year, InMed Pharmaceuticals Inc. (Nasdaq: INM) made the executive decision to forge a new path alongside its traditional domain in pharmaceutical drug development. With the acquisition long since closed, the end results are starting to bear fruit. The company has already launched B2B sales of the rare cannabinoid cannabidivarin (CBDV) in the U.S. health and wellness sector. This is but a preview of additional product launches that will be introduced to market in the coming quarters.

High up on the priority list is tetrahydrocannabivarin (THCV), a cannabinoid chemical found in cannabis that shares broad similarities in molecular structure to tetrahydrocannabinol THC. Incredibly, the reduction of one sidechain, thereby reducing the molecule by two carbons, producing enough of a differentiated effect that preliminary research suggests that THCV could provide distinctive benefits to consumers—particularly at titrated doses.

According to Jay Denniston, chief scientist at BellRock Brands, THCV is a unique cannabinoid that has potential therapeutic benefits for both appetite control and to provide a focused, energetic sense of euphoria. “At …

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The 7-Hour Itch: 3 Women With Eczema Describe the Ways They Combat Nighttime Flare-Ups




If you have eczema, you know what it’s like – that frustrating struggle to catch some ZZZ’s.

The problem is at once physical and emotional. “When my eczema is flared, nighttime often fills me with anxiety,” says Nicola Johnston, a digital content creator who lives in Carlisle, England, near the border of Scotland. “I have experienced nights in so much pain that I cannot sleep, and I’ve scratched so hard that my sheets were covered in blood. This is why I’ve worked to establish a good evening routine that will allow me to have a comfortable night’s sleep and get the rest that my body needs.”

But that rest can be elusive when you’re tormented by “itching, flaky skin, raised red rashes, cuts, skin tightness,” the symptoms listed by Elise Loubatieres, a London-based editor and beauty influencer. In many patients, eczema is itchiest at night, sometimes due to a lack of time for self-care earlier in the day. Natalie Findley, a holistic chef from Whistler, British Columbia, has had a similar experience. “Nighttime flare-ups taught me that something wasn’t working,” she says. “Not getting enough sleep was not doing me any good.”

If you want to turn down eczema flare-ups, finding out what works best for you calls for trial and error. But it also helps to get advice from people who understand firsthand what you’re going through. Here, three women who’ve been there offer tips on how to prepare for bed, get as comfy as possible, deal with symptoms, and reset your emotions in the morning.

Getting Ready for Bed

When it comes to preparing for bed, Findley favors consistency. “I try to keep my routine the same each night,” she says. Before doing anything, she sets “an intention to sleep better.” From there, Findley likes “to cleanse and moisturize my skin, drink some herbal tea, do some journaling, read, express gratitude, and then I am in bed by 10 p.m.”

An equally firm believer in the step-by-step approach, Johnston focuses first and foremost on comfort. “I start my bedtime routine by having a lukewarm bath to soothe my skin, if my skin is feeling particularly flared,” she says. “I then apply an emollient-based product that is going to lock in moisture and be slowly absorbed through the night. I put on lightweight satin nightwear that keeps me cool. In making up my bed, I personally prefer a silk pillow, as this is gentler on my facial eczema and doesn’t absorb any product I apply to my face like a cotton material would.”

Loubatieres scrupulously preps her skin and takes medication to prevent symptoms later. “I have been prescribed antihistamines to help with the itching,” she explains. “I also make sure that I apply emollients to my skin liberally and frequently in the hour leading up to bedtime.”

Under the Covers

To Findley, the choice of bedding fabric is less important than the way it’s washed. “I don’t use any particular kind of sheets to relieve my eczema, but I use natural and clean laundry detergents.” she says. “Even though many regular products claim to be clean, they use a lot of harmful chemicals and ingredients in detergents that aggravate eczema and your overall health. I use detergents that are hypoallergenic and without any fragrances. My favorite laundry detergent is Tru Earth.” Her bedside companion is also natural and gentle: “If I need some relief, I always use calendula and comfrey-based salve, with some shea butter, to calm the itchiness and dry skin.”

Johnston has an unusual trick for dealing with one of eczema’s side effects – a trick that involves a trip to the nail salon. “A great tip I have found is having acrylic gel manicures,” she notes. “It means that your nail itself becomes thicker and doesn’t break your skin when you’re scratching in the night. This has been a great help with healing my eczema.”

Aware that overheating can bring on eczema, Loubatieres takes a proactive approach. “I try to stay cool using a stand-alone fan, and I also use a handheld fan to pinpoint itchy areas for some relief,” she says. “I ensure that my sheets and sleepwear are either 100% cotton or silk to reduce irritation. I also have eczema gloves and Cosi Care [aka “safe scratchers”], which are itching tools that allow you to satisfy an itch without causing damage.”

When You Can’t Sleep

Whenever she begins to feel itchy, Findley does simple breathing exercises to calm her body. “I close my eyes, breathe in slowly and count to five, and hold for 2 seconds, then breathe out slowly and count to seven. Or I will just breathe in slowly until my chest and belly are full with air, hold for a few seconds, and breathe out slowly all the way. I repeat this multiple times until I’m relaxed. I also imagine myself sinking into my pillow as I breathe out, and it relaxes me and my muscles until I finally fall asleep.”

Johnston tries to nap during the day whenever possible. That way, in the event of a nighttime flare-up, she’s not completely exhausted the next day, And the extra rest is also calming. “By keeping my daytime stress levels to a minimum,” she says, flare-ups become less likely.

As Loubatieres sees it, you’ve lost the battle when you give in to the urge to itch. “At night I tend to get what I call ‘scratch attacks,’ where I uncontrollably and incessantly scratch despite breaking skin and causing myself pain,” she says. “It feels very satisfying in the moment and provides relief from that bone-deep itching sensation. But I try to get up and distract myself in some way. If I stay in bed and don’t keep my hands busy, I’m more likely to indulge in a scratch.” Indeed, taking up a hobby – drawing, knitting, playing guitar, anything that involves using your hands – can be an ideal diversion between a flare-up and the welcome moment when you feel really sleepy.

The Morning After

In the light of day, after successfully dealing with her nighttime flare-ups, Findley developed a fresh philosophy. “I made it a habit to clean up my diet and reduce stress and anxiety with meditation, journaling, and sleep hygiene. To treat the root cause of my issue, I switched to a plant-based diet. I also cut out dairy, as it’s pretty inflammatory. … I drink a lot of water each day. Now my eczema has cleared up! I find that fueling your body with the proper nutrients will support your immune system, therefore improving your eczema.”

Johnston emphasizes the importance of knowing your true self. “Often, it feels like you are your eczema, like it’s a defining characteristic,” she says. “It’s important to learn that your value comes from you and not your skin. I also learned to be kind to my skin. Not looking at it with hatred and resentment, but to see my eczema as a friend that was telling me there is an imbalance somewhere that I need to put right. It’s really important to listen to your body and notice your triggers.”

Whatever strategies you adopt, Loubatieres says, you should treat yourself with compassion. “After a scratch attack, I personally get a huge amount of guilt,” she admits. “I think I’ve caused my skin a lot of harm. However, I have to remind myself that it’s a condition that I cannot control. Skin eventually heals.” Her best advice for getting a good night’s sleep: “Don’t be so hard on yourself.”

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