Study: Race-free eGFR equations may reclassify Black adults into more advanced CKD stages
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Key takeaways:
- Of patients with CKD stages 3 to 5, 45.8% of Black adults were reclassified to more advanced stages.
- Overall, 44% of a comparison group of patients who were not Black were reclassified to less severe stages.
In a study using U.S. Military Health System data, adoption of the 2021 Chronic Kidney Disease Epidemiology Collaboration equation that removes a race coefficient to determine eGFR may reclassify Black adults into more advanced CKD stages.
“For over [2] decades, the calculation of estimated glomerular filtration rate (eGFR) has included an adjustment factor for race because of data showing that Black adults on average have higher serum creatinine than other racial or ethnic groups,” James D. Oliver III, MD, PhD, of the Walter Reed National Military Medical Center, wrote with colleagues. “However, the clinical implications of excluding race in estimations of kidney function are not yet known.”
Oliver and colleagues performed a retrospective calculation of eGFR from serum creatinine measured between 2016 and 2019, using the 2009 and 2021 Chronic Kidney Disease Epidemiology Collaboration equations, to assess the impact on CKD prevalence in a diverse group.
The researchers used multicenter health care network data from 1,502,607 adults in the complete case analysis and from 1,970,433 adults in imputed race analysis.
According to the study, patients self-reported their race as Black, white, Asian American and Pacific Islander, American Indian and Alaska Native, other or unknown. Researchers compared data regarding “Black race to the combined category of non-Black race” as part of the study.
The complete case analysis cohort had a median age of 40 years; 18.8% of participants were Black and 35.4% were women.
Age, sex and race were accounted for, and CKD stages 3 through 5 were defined as the last eGFR persistently measuring less than 60 mL/min/1.73 m2 for at least 90 days.
With the 2021 equation, researchers found the number of Black adults with CKD stages 3 through 5 increased 58.1% from 4,147 to 6,556 for a crude prevalence change from 1.47% to 2.32%. The number of adults in the comparison group with the same CKD stages decreased 30.4% from 27,596 to 19,213 for a crude prevalence change from 2.26% to 1.58%.
Overall, of adults with CKD stages 3 through 5, 45.8% of Black patients were reclassified to more advanced CKD stages and 44% of the comparison group were reclassified to less severe stages across eGFR thresholds, according to Oliver and researchers.
“The removal of race as a factor in quantifying kidney function may be an important step in addressing disparities in the care and outcomes of chronic kidney disease,” they wrote. “However, it is not without risk and the challenge is on health care providers and systems to maintain focus on both health and health care equity as well as personalized care in individuals with kidney disease.”
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