Exclusion of race may lead to classification of living kidney donor as having CKD
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ORLANDO —Use of the 2021 Chronic Kidney Disease Epidemiology Collaboration eGFR formula may lead to incorrect classification of Black living kidney donors as having CKD, according to data presented here.
“The final messaging for this is the new eGFR, that is a race-neutral eGFR. One has to understand what it really means. No equation is perfect. In trying to correct one issue, we may unintentionally generate another issue,” Vineeta Kumar, MD, from the University of Alabama at Birmingham, told Healio Nephrology. “If you aren’t aware of it, we can do disservice to the very patients we are wanting to help.”
Kumar and colleagues used a national database to identify 63,246 living kidney donors with pre-donation eGFR greater than 60 mL/min/1.73 m2. Overall, 11.2% of the living kidney donors were Black with a mean creatinine of 0.88 mg/dL.
Kumar and colleagues found that the eGFR of Black living kidney donors was 109.7 mL/min/1.73 m2 and 97.7 mL/min/1.73 m2 when using the 2009 and 2021 formulas, respectively. Additionally, 17.7% of Black living kidney donors had been reclassified with higher pre-donation CKD stages when the 2021 formula was used.
Of the 44,525 living kidney donors who had more than two creatinine measurements taken after their kidney donations, 9.3% of the patients were Black with mean creatinine of 1.24 mg/dL. The mean eGFR for Black living kidney donors was 73.2 mL/min/1.73 m2 and 65.6 mL/min/1.73 m2 when using the 2009 and 2021 formulas, respectively. Additionally, 25.5% of Black living kidney donors had been reclassified with a higher pre-donation CKD stage when the 2021 formula was used.
“Estimated GFRs are never perfect. They are never going to be a ‘one size fits all’ for everybody. We have to inform it with additional understanding, so that is more education. Then transition, when there is a question, from estimated to measured eGFRs,” Kumar said.
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Kumar V, et al. TH-PO729. Presented at: ASN Kidney Week; Nov. 3-6, 2022; Orlando (hybrid meeting).
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