Evaluating the Impact and Rationale of Race-Specific Estimations of Kidney Function: Estimations from U.S. NHANES, 2015-2018

ABSTRACT: Background: Standard equations for estimating glomerular filtration rate (eGFR) employ race multipliers, systematically inflating eGFR for Black patients. Such inflation is clinically significant because eGFR thresholds of 60, 30, and 20 ml/min/1.73m2 guide kidney disease management. Raci...

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Autores principales:	Jennifer W. Tsai, MD, M.Ed, Jessica P. Cerdeña, M.Phil, William C. Goedel, PhD, William S. Asch, MD, PhD, Vanessa Grubbs, MD, MPH, Mallika L. Mendu, MD, MBA, Jay S. Kaufman, PhD
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Race Coefficient Race Adjustment eGFR MDRD CKD-EPI Cystatin C Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/b1908a9d5bf042828998bedc6423665c
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spelling	oai:doaj.org-article:b1908a9d5bf042828998bedc6423665c2021-11-22T04:28:54ZEvaluating the Impact and Rationale of Race-Specific Estimations of Kidney Function: Estimations from U.S. NHANES, 2015-20182589-537010.1016/j.eclinm.2021.101197https://doaj.org/article/b1908a9d5bf042828998bedc6423665c2021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2589537021004788https://doaj.org/toc/2589-5370ABSTRACT: Background: Standard equations for estimating glomerular filtration rate (eGFR) employ race multipliers, systematically inflating eGFR for Black patients. Such inflation is clinically significant because eGFR thresholds of 60, 30, and 20 ml/min/1.73m2 guide kidney disease management. Racialized adjustment of eGFR in Black Americans may thereby affect their clinical care. In this study, we analyze and extrapolate national data to assess potential impacts of the eGFR race adjustment on qualification for kidney disease diagnosis, nephrologist referral, and transplantation listing. Methods: Using population-representative cross-sectional data from the United States National Health and Nutrition Examination Survey (NHANES) from 2015-2018, eGFR values for Black Americans were calculated using the Modification of Diet in Renal Disease (MDRD) equation with and without the 1.21 race-specific coefficient using cohort data on age, sex, race, and serum creatinine. Findings: Without the MDRD eGFR race adjustment, 3.3 million (10.4%) more Black Americans would reach a diagnostic threshold for Stage 3 Chronic Kidney Disease, 300,000 (0.7%) more would qualify for beneficial nephrologist referral, and 31,000 (0.1%) more would become eligible for transplant evaluation and waitlist inclusion. Interpretation: These findings suggest eGFR race coefficients may contribute to racial differences in the management of kidney. We provide recommendations for addressing this issue at institutional and individual levels. Funding: No external funding was received for this study.Jennifer W. Tsai, MD, M.EdJessica P. Cerdeña, M.PhilWilliam C. Goedel, PhDWilliam S. Asch, MD, PhDVanessa Grubbs, MD, MPHMallika L. Mendu, MD, MBAJay S. Kaufman, PhDElsevierarticleRace CoefficientRace AdjustmenteGFRMDRDCKD-EPICystatin CMedicine (General)R5-920ENEClinicalMedicine, Vol 42, Iss , Pp 101197- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Race Coefficient Race Adjustment eGFR MDRD CKD-EPI Cystatin C Medicine (General) R5-920
spellingShingle	Race Coefficient Race Adjustment eGFR MDRD CKD-EPI Cystatin C Medicine (General) R5-920 Jennifer W. Tsai, MD, M.Ed Jessica P. Cerdeña, M.Phil William C. Goedel, PhD William S. Asch, MD, PhD Vanessa Grubbs, MD, MPH Mallika L. Mendu, MD, MBA Jay S. Kaufman, PhD Evaluating the Impact and Rationale of Race-Specific Estimations of Kidney Function: Estimations from U.S. NHANES, 2015-2018
description	ABSTRACT: Background: Standard equations for estimating glomerular filtration rate (eGFR) employ race multipliers, systematically inflating eGFR for Black patients. Such inflation is clinically significant because eGFR thresholds of 60, 30, and 20 ml/min/1.73m2 guide kidney disease management. Racialized adjustment of eGFR in Black Americans may thereby affect their clinical care. In this study, we analyze and extrapolate national data to assess potential impacts of the eGFR race adjustment on qualification for kidney disease diagnosis, nephrologist referral, and transplantation listing. Methods: Using population-representative cross-sectional data from the United States National Health and Nutrition Examination Survey (NHANES) from 2015-2018, eGFR values for Black Americans were calculated using the Modification of Diet in Renal Disease (MDRD) equation with and without the 1.21 race-specific coefficient using cohort data on age, sex, race, and serum creatinine. Findings: Without the MDRD eGFR race adjustment, 3.3 million (10.4%) more Black Americans would reach a diagnostic threshold for Stage 3 Chronic Kidney Disease, 300,000 (0.7%) more would qualify for beneficial nephrologist referral, and 31,000 (0.1%) more would become eligible for transplant evaluation and waitlist inclusion. Interpretation: These findings suggest eGFR race coefficients may contribute to racial differences in the management of kidney. We provide recommendations for addressing this issue at institutional and individual levels. Funding: No external funding was received for this study.
format	article
author	Jennifer W. Tsai, MD, M.Ed Jessica P. Cerdeña, M.Phil William C. Goedel, PhD William S. Asch, MD, PhD Vanessa Grubbs, MD, MPH Mallika L. Mendu, MD, MBA Jay S. Kaufman, PhD
author_facet	Jennifer W. Tsai, MD, M.Ed Jessica P. Cerdeña, M.Phil William C. Goedel, PhD William S. Asch, MD, PhD Vanessa Grubbs, MD, MPH Mallika L. Mendu, MD, MBA Jay S. Kaufman, PhD
author_sort	Jennifer W. Tsai, MD, M.Ed
title	Evaluating the Impact and Rationale of Race-Specific Estimations of Kidney Function: Estimations from U.S. NHANES, 2015-2018
title_short	Evaluating the Impact and Rationale of Race-Specific Estimations of Kidney Function: Estimations from U.S. NHANES, 2015-2018
title_full	Evaluating the Impact and Rationale of Race-Specific Estimations of Kidney Function: Estimations from U.S. NHANES, 2015-2018
title_fullStr	Evaluating the Impact and Rationale of Race-Specific Estimations of Kidney Function: Estimations from U.S. NHANES, 2015-2018
title_full_unstemmed	Evaluating the Impact and Rationale of Race-Specific Estimations of Kidney Function: Estimations from U.S. NHANES, 2015-2018
title_sort	evaluating the impact and rationale of race-specific estimations of kidney function: estimations from u.s. nhanes, 2015-2018
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/b1908a9d5bf042828998bedc6423665c
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Evaluating the Impact and Rationale of Race-Specific Estimations of Kidney Function: Estimations from U.S. NHANES, 2015-2018

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