Fighting for equal renal care

This issue looks at race in clinical algorithms, dialysis for undocumented patients, and inpatient care for Native American patients.

One thing 2020 accomplished was to raise awareness about inequalities and injustices in our society. This issue focuses on a couple of those problems that particularly affect patients with kidney disease. First, we look at how race is used in calculating estimated glomerular filtration rate, as well as many other clinical algorithms. Experts who have studied these race correctors explain how they don't make biological sense and offer examples of potential harms from their use, particularly for Black patients.

The harms of not providing access to outpatient dialysis are obvious. This issue's other main story looks at the obstacles facing undocumented immigrants who need dialysis. They aren't eligible for insurance under the Affordable Care Act, and in many states, Medicaid will only cover their treatment when they're sick enough to be admitted, if at all. The article tells how some hospitalists and nephrologists have been working to change the system and save both patients and health care costs.

A happier tale of health care improvement and cross-cultural collaboration is provided by another article. Physicians at a New Mexico hospital collaborated with peers working for the Indian Health Service to optimize care for Native American patients. They and other experts offer their tips on communicating well and generally providing culturally competent care.

Finally, don't let a high blood pressure reading drive you to prescribe a patient excessive antihypertensive therapy, during or after admission, according to conference coverage in this issue. A lecture at Hypertension 2020, held virtually in September, offered advice specifically for hospitalists. We always try to do the same. If you have thoughts to share about ACP Hospitalist at any time, please email us at

Stacey Butterfield