Race coefficient in GFR equations impacts preemptive listing for kidney transplantation
Removing the race coefficient in eGFR equations may increase equitable distribution of Black candidates listed earlier for kidney transplantation on a preemptive basis, according to data published in the Clinical Kidney Journal.
“Race coefficients of eGFR formulas may be partially responsible for racial inequality in preemptive listing for kidney transplantation,” Vinay Nair, DO, from the departments of medicine and surgery at Northwell Health in Manhasset, New York, and colleagues wrote. “Utilizing the Scientific Registry of Transplant Recipients (SRTR), we quantified differences in preemptive listing among patients listed for kidney transplantation before and after applying race coefficients to both Black and non-Black transplant candidates.”
Nair and colleagues evaluated 385,087 adult candidates waitlisted for kidney transplantation between Jan. 1, 2010, and Dec. 2, 2020. Additionally, researchers categorized candidates who did not require dialysis or were listed before dialysis initiation as preemptive (n=118,329; 71.7% were white; 19% were Black; 7.8% were Asian; 0.6% were multi-racial; 0.6% were Native American; 0.3% were Pacific Islander); candidates who initiated dialysis before listing date were categorized as non-preemptive.
Because the SRTR did not report which eGFR equation was used, researchers assumed that the “African American race coefficient” was applied to all Black patients, so they applied it to all preemptively listed patients who were not Black as well. Researchers used the Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas to estimate eGFR.
Following eGFR modulation, researchers excluded Black patients with an eGFR greater than or equal to 20mL/min/1.73 m².
Analyses revealed that compared with Black candidates, the adjusted odds of preemptive listing for white candidates declined from 2.01 before modulation to 1.18 with the MDRD and 1.37 with the CKD-EPI formulas after adjusting for race coefficients.
“Our data show significant racial disparities derived from the inclusion of race coefficients when calculating eGFR at the time of preemptive listing of Black kidney transplant candidates. Preemptive listing rates more closely mirrored wait list rates per race when all races were subject to the Black race GFR-calculation coefficients. Residual differences suggest other factors outside of this scope of this study should also be investigated,” Nair and colleagues wrote. “Future prospective studies should re-evaluate preemptive listing rates in the upcoming era without the inclusion of race in GFR estimation formulas.”
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