Kidney Week 2025 Annual Meeting-Promoting Justice in Kidney Health, Including the Christopher R. Blagg, MD, Endowed Lectureship in Kidney Diseases and Public Policy

Video Transcription

Video Summary

The session “Promoting Justice in Kidney Health,” hosted by Gary Singer and Ray Bignall, honored dialysis pioneer Christopher Blagg and framed kidney health justice as patient-centered, equity-grounded care.<br /><br />Keith Norris argued that race is a social—not biologic—construct and should not be used to modify eGFR or choose therapies. Race/ethnicity can be useful for population-level surveillance and identifying disparities, but clinical decisions should rely on direct patient data (labs, pathology, physiology) and, when relevant, specific gene variants—not “ancestry markers.” He emphasized measuring underlying drivers (structural discrimination, social determinants), building trust in research participation, and practicing anti-discriminatory, individualized shared decision-making.<br /><br />Janushka Mohottige discussed how AI and clinical algorithms can worsen inequities when trained on biased data or flawed proxies (e.g., cost as a proxy for need). She reviewed bias sources across the AI lifecycle (missingness, sampling, measurement, historical bias, drift) and highlighted that “fairness” has competing technical definitions. She advocated for equity embedded throughout development, transparency, community engagement, auditing by subgroup, human oversight, and “de-implementation” plans when harms are identified—warning that AI cannot substitute for addressing structural injustice.<br /><br />Yuvaram Reddy focused on policy and regulation, defining kidney health parity as health equity. He described how federal actions (executive orders, CMS payment models) can promote or erase equity incentives. Using the ESRD Treatment Choices model, he showed how equity adjustments reduced penalties for safety-net dialysis facilities, but noted shifting political environments and Medicaid policy changes threaten access.<br /><br />Becky Schmidt shared practical strategies to expand rural/underserved kidney care: decentralized clinics, telemedicine, PCP education (e.g., ECHO), community partnerships, workforce supports, and locally tailored outreach—showing improved outpatient dialysis starts and home dialysis uptake with reduced travel burdens.

Asset Subtitle

Moderator(s): O. N. Ray Bignall, Gary Singer

Presentation(s):

Best Practices for Integrating Race, Ethnicity, and Ancestry in Kidney Care and Research: The Christopher R. Blagg, MD, Endowed Lectureship in Kidney Diseases and Public Policy - Keith Norris
Addressing Bias in Artificial Intelligence and Machine Learning for Kidney Health - Dinushika Mohottige
Safeguarding Kidney Health Parity in a Changing Regulatory Environment - Yuvaram Reddy
Strategies for Expanding Kidney Care to Rural and Underserved Communities - Rebecca Schmidt

ASN gratefully acknowledges the Northwest Kidney Centers and its contributors for support of the Blagg Lectureship.

ASN thanks the ASN Health Care Justice Committee for assistance with this session.

Note: Continuing education credits are not being offered for this session.

Meta Tag

Date 11/7/2025

Pathway 1 Other

Session ID 507257

Keywords

kidney health justice

health equity

dialysis pioneer Christopher Blagg

patient-centered care

race and eGFR adjustment

race as social construct

shared decision-making

structural discrimination

social determinants of health

genetic variants in nephrology

AI bias in healthcare

algorithmic fairness

clinical algorithm auditing

CMS ESRD Treatment Choices model

rural kidney care and telemedicine