Anti-Black racism in Canadian clinical tools

Thank you for your article. It had relevance in our home.

My husband is an Afro decedent who has ancestors from St Kitts/Nevis and Guyana. As a middle aged man whose father died too young of prostate cancer, he sees his family physician yearly and receives his yearly bloodwork including Creatinine (Cr). Even though we do not have Type 2 DM or hypertension, our respective family doctors yearly order Cr. I do the same. I am beginning to question this practice.

It was a journey of turning a person into a patient then back to a person. Although his Cr was at the high end of normal for years. Last May, it was slightly above normal. A 3 month repeat, it was still above the normal value. He accepted the Nephrology consult offered. He exercised more. Then he completed the requisite bloodwork before seeing the specialist. The Cr increased by 25!

Until I completed a search, I was not aware of the limitations of Cr to estimate glomerular filtration rates (GFR) in Black people. The nephologist ordered Cystatin C (Cys). His calculations using Cr and Cys revealed that the Cr UNDERESTIMATED my husband's GFR by 50%!!

We are grateful Cystatin C exists but primary doctors cannot order the test in Alberta. We wish there was a better test that is widely used to estimate GFR than Creatinine. But I am also wondering if there are no risk factors for kidney disease, should I order the Cr?