The Implication of Dropping Race from the MDRD Equation to Estimate GFR in an African American-Only Cohort

The widely used Modification of Diet in Renal Disease (MDRD) formula adapts a 1.212 multiplier for individuals who are identified as African Americans (AAs) or Blacks, which leads to a higher GFR estimation. As it stands, AAs have a lower prevalence of chronic kidney disease (CKD) but higher inciden...

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Autores principales:	Ernie Yap, Yelyzaveta Prysyazhnyuk, Jie Ouyang, Isha Puri, Carla Boutin-Foster, Moro Salifu
Formato:	article
Lenguaje:	EN
Publicado:	Hindawi Limited 2021
Materias:	Diseases of the genitourinary system. Urology RC870-923
Acceso en línea:	https://doaj.org/article/e1e8e43766744b89b387f48f1476372e
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spelling	oai:doaj.org-article:e1e8e43766744b89b387f48f1476372e2021-11-29T00:55:31ZThe Implication of Dropping Race from the MDRD Equation to Estimate GFR in an African American-Only Cohort2090-215810.1155/2021/1880499https://doaj.org/article/e1e8e43766744b89b387f48f1476372e2021-01-01T00:00:00Zhttp://dx.doi.org/10.1155/2021/1880499https://doaj.org/toc/2090-2158The widely used Modification of Diet in Renal Disease (MDRD) formula adapts a 1.212 multiplier for individuals who are identified as African Americans (AAs) or Blacks, which leads to a higher GFR estimation. As it stands, AAs have a lower prevalence of chronic kidney disease (CKD) but higher incidence of end-stage renal disease (ESRD) compared with Whites. Many hypotheses have been postulated to explain this paradox, but the imprecision of the GFR estimation with race-adaptation could be contributory. We performed a single-center, longitudinal, retrospective study on a cohort of outpatient AA patients using the MDRD and MDRDrace removed and CKD-EPI and CKD-EPIrace removed and their progression to CKD G5 (eGFR <15 ml/min/1.73 m2). 327 patients were analyzed. Median follow-up was 88.1 months (interquartile range, 34.4–129.1). When race was removed from MDRD, 39.9% of patients in CKD G1/2 were reclassified to CKD G3a, 72.6% of patients in CKD G3a would be reclassified to CKD G3b, and 54.1% and 36.4% of patients would be reclassified from CKD 3b to CKD G4 and CKD G4 to CKD G5, respectively p<0.0001. Comparing the CKD-EPI formula against the MDRD in our cohort, we found that 8.2%, 18.8%, and 11.4% of patients were reclassified from CKD G1/2 to CKD G3a, CKD G3a to G3b, and CKD G3b to CKD G4 respectively. Overall median time to progression to CKD G5 was 137.4 (131.9–142.8) months in patients who were not reclassified and 133.6 (127.6–139.6) months for patients who were reclassified by MDRDrace removedp<0.288. Concerns of inequitable access to healthcare have elicited calls to review race-corrected eGFR equations. A substantial number of individuals would have their CKD stage reclassified should have the MDRDrace removed equation be adopted en masse on an AA-only population. The discrepancy is highest at the 45–59 and >60 ml/min/1.72 min2 ranges. This will have tremendous impact on our center’s approach to pharmacological dosing, referral system, best practices, and outcome surveillance. Comprehensive review of the current “race-corrected” eGFR will require a multifaceted approach and adjunctive use of noncreatinine-based approach.Ernie YapYelyzaveta PrysyazhnyukJie OuyangIsha PuriCarla Boutin-FosterMoro SalifuHindawi LimitedarticleDiseases of the genitourinary system. UrologyRC870-923ENInternational Journal of Nephrology, Vol 2021 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the genitourinary system. Urology RC870-923
spellingShingle	Diseases of the genitourinary system. Urology RC870-923 Ernie Yap Yelyzaveta Prysyazhnyuk Jie Ouyang Isha Puri Carla Boutin-Foster Moro Salifu The Implication of Dropping Race from the MDRD Equation to Estimate GFR in an African American-Only Cohort
description	The widely used Modification of Diet in Renal Disease (MDRD) formula adapts a 1.212 multiplier for individuals who are identified as African Americans (AAs) or Blacks, which leads to a higher GFR estimation. As it stands, AAs have a lower prevalence of chronic kidney disease (CKD) but higher incidence of end-stage renal disease (ESRD) compared with Whites. Many hypotheses have been postulated to explain this paradox, but the imprecision of the GFR estimation with race-adaptation could be contributory. We performed a single-center, longitudinal, retrospective study on a cohort of outpatient AA patients using the MDRD and MDRDrace removed and CKD-EPI and CKD-EPIrace removed and their progression to CKD G5 (eGFR <15 ml/min/1.73 m2). 327 patients were analyzed. Median follow-up was 88.1 months (interquartile range, 34.4–129.1). When race was removed from MDRD, 39.9% of patients in CKD G1/2 were reclassified to CKD G3a, 72.6% of patients in CKD G3a would be reclassified to CKD G3b, and 54.1% and 36.4% of patients would be reclassified from CKD 3b to CKD G4 and CKD G4 to CKD G5, respectively p<0.0001. Comparing the CKD-EPI formula against the MDRD in our cohort, we found that 8.2%, 18.8%, and 11.4% of patients were reclassified from CKD G1/2 to CKD G3a, CKD G3a to G3b, and CKD G3b to CKD G4 respectively. Overall median time to progression to CKD G5 was 137.4 (131.9–142.8) months in patients who were not reclassified and 133.6 (127.6–139.6) months for patients who were reclassified by MDRDrace removedp<0.288. Concerns of inequitable access to healthcare have elicited calls to review race-corrected eGFR equations. A substantial number of individuals would have their CKD stage reclassified should have the MDRDrace removed equation be adopted en masse on an AA-only population. The discrepancy is highest at the 45–59 and >60 ml/min/1.72 min2 ranges. This will have tremendous impact on our center’s approach to pharmacological dosing, referral system, best practices, and outcome surveillance. Comprehensive review of the current “race-corrected” eGFR will require a multifaceted approach and adjunctive use of noncreatinine-based approach.
format	article
author	Ernie Yap Yelyzaveta Prysyazhnyuk Jie Ouyang Isha Puri Carla Boutin-Foster Moro Salifu
author_facet	Ernie Yap Yelyzaveta Prysyazhnyuk Jie Ouyang Isha Puri Carla Boutin-Foster Moro Salifu
author_sort	Ernie Yap
title	The Implication of Dropping Race from the MDRD Equation to Estimate GFR in an African American-Only Cohort
title_short	The Implication of Dropping Race from the MDRD Equation to Estimate GFR in an African American-Only Cohort
title_full	The Implication of Dropping Race from the MDRD Equation to Estimate GFR in an African American-Only Cohort
title_fullStr	The Implication of Dropping Race from the MDRD Equation to Estimate GFR in an African American-Only Cohort
title_full_unstemmed	The Implication of Dropping Race from the MDRD Equation to Estimate GFR in an African American-Only Cohort
title_sort	implication of dropping race from the mdrd equation to estimate gfr in an african american-only cohort
publisher	Hindawi Limited
publishDate	2021
url	https://doaj.org/article/e1e8e43766744b89b387f48f1476372e
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The Implication of Dropping Race from the MDRD Equation to Estimate GFR in an African American-Only Cohort

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