CERCA
Coalition to End Racism in Clinical Algorithms
A formula shouldn’t decide who gets referred for a transplant.
For decades, the standard equation used to estimate kidney function included a built-in adjustment for Black patients. That race adjustment increased estimated kidney function values for Black patients, which could influence CKD staging and related clinical decisions such as specialty referrals, transplant evaluation, and disease management.
CERCA, the NYC Coalition to End Racism in Clinical Algorithms, is a citywide initiative led by the New York City Department of Health and Mental Hygiene. As part of that DOHMH-led coalition effort, the New York Academy of Medicine was engaged to conduct evaluation and implementation research examining what happened when the race adjustment was removed from the estimated Glomerular Filtration Rate (eGFR) equation at two NYC safety-net health systems. The research, supported through the Doris Duke Charitable Foundation as part of the broader CERCA initiative, studied the real-world effects of this change across patient records spanning 2018 to 2024.
Featured: “1.159 If Black”
OFFICIAL SELECTION • URBANWORLD FILM FESTIVAL • OCTOBER 14–18, 2026 • NEW YORK CITY
1.159 is the multiplier that some race-based eGFR equations applied to Black patients’ lab results for years, increasing estimated kidney function values and shaping how kidney disease could appear on paper.
NYAM’s new animated short film, 1.159 if Black, grew out of the issues explored through CERCA and NYAM’s broader interest in helping patients, clinicians, and community members understand how race-based algorithms can shape healthcare decisions. Made with support from a donor, and not funded through CERCA or the Doris Duke Charitable Foundation, the film is less a technical explanation of chronic kidney disease than a conversation starter about the history, implications, and human impact of race-based clinical algorithms.
What we found in research
With support through the Doris Duke Charitable Foundation as part of the broader CERCA initiative, the quantitative arm of NYAM’s evaluation and implementation research analyzed Electronic Medical Record (EMR) data from patients with a CKD diagnosis to examine changes in CKD staging, nephrology referral rates, and transplant discussion documentation before and after the race variable was removed.
Following de-implementation of the race variable, these disparities were corrected.
What people told us
The qualitative arm of the study involved in-depth interviews with three distinct groups, each offering a different vantage point on the same policy change.
We conducted in-depth interviews with clinicians, patients living with CKD, and policy leaders and legal experts. Together, these conversations surfaced the practical barriers to changing clinical workflows, the lived experience of patients most affected by the prior algorithm, and the broader policy landscape shaping equitable access to kidney transplant care.
Go deeper
NYC Health Department: Coalition to End Racism in Clinical Algorithms (CERCA)
An overview of the citywide coalition, its member health systems, and its published evaluations and reports.
Removing Harmful Race-Based Clinical Algorithms: A Toolkit — Digital Medicine Society (DiMe)
A practical, five-step toolkit, built on CERCA’s real-world experience, to help other health systems de-implement race-based clinical algorithms.