GFR Estimation in Potential Living Kidney Donors: Race- and Nonrace-based Equations and Measured GFR

Goodson, David Alex; Chalupsky, Megan R.; Wiegley, Nasim; Huang, Yuning; Chiu, Mark L.; Bang, Heejung; Roshanravan, Baback; Young, Brian; Chen, Ling Xin

doi:10.1016/j.xkme.2022.100558

Cited by 6 publications

(19 citation statements)

References 37 publications

(48 reference statements)

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“…We found that use of equation. 13 In a subset of 37 Black donor candidates, the investigators found that the eGFRcr2021 equation underestimated measured GFR by 9 mL/min/1.73 m 2 , similar to our findings. Their analysis, however, did not include GFR estimates using cystatin C-based equations.…”

Section: Discussionsupporting

confidence: 88%

“…Inker et al included a subset of Black living donor candidates in their development and validation of 2021 eGFR equations, but did not analyze these donor candidates independently 2 More recently, Goodson et al. examined measured GFR in comparison with eGFR using the eGFRcr2021 equation 13 . In a subset of 37 Black donor candidates, the investigators found that the eGFRcr2021 equation underestimated measured GFR by 9 mL/min/1.73 m 2 , similar to our findings.…”

Section: Discussionsupporting

confidence: 75%

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Performance of estimated glomerular filtration rate equations in Black living kidney donor candidates

Augustine,

Liaqat,

Arrigain

et al. 2023

Clinical Transplantation

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IntroductionNew estimated glomerular filtration rate (eGFR) equations using serum creatinine and/or cystatin C have been derived to eliminate adjustment by perceived Black ancestry. We sought to analyze the performance of newer eGFR equations among Black living kidney donor candidates.MethodsBlack candidates (n = 64) who had measured iothalamate GFR between January 2015 and October 2021 were included, and eGFR was calculated using race adjusted (eGFRcr2009 and eGFRcr‐cys2012) and race unadjusted (eGFRcys2012, eGFRcr2021, and eGFRcr‐cys2021) CKD‐EPI equations. Bias and accuracy were calculated.ResultsThe eGFRcr2021 equation had a negative bias of 9 mL/min/1.73 m2, while other equations showed a modest positive bias. Accuracy within 10% and 30% was greatest using the eGFRcr‐cys2021 equation. With the eGFRcr2021 equation, 9.4% of donors with an mGFR > 80 mL/min/1.73 m2 were misclassified as having an eGFR < 80 mL/min/1.73 m2. eGFR was also compared among 18 kidney donors at 6–24 months post‐donation. Post‐donation, the percentage of donors with an eGFR < 60 mL/min/1.73 m2 was 44% using the eGFRcr2021 equation compared to 11% using the eGFRcr‐cys2021 equation.ConclusionThe CKD‐EPICr2021 equation appears to underestimate true GFR in Black living donor candidates. Alternatively, compared to CKD‐EPICr2021, the CKD‐EPICr‐CysC2021 equation appears to perform with less bias and improved accuracy.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 75%

Performance of estimated glomerular filtration rate equations in Black living kidney donor candidates

Augustine,

Liaqat,

Arrigain

et al. 2023

Clinical Transplantation

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“…This systematic review and meta-analysis analyzed 12 studies [18][19][20][21][22][23][24][25][26][27][28][29]…”

Section: Discussionmentioning

confidence: 99%

“…Three equations reported a P 30 greater than 95% in non-Black participants, whereas only 1 equation reported a P 30 greater than 90% in Black participants. 22 In studies using creatinine-cystatin C-based equations,…”

Section: Accuracy Comparing Black and Non-black Participants In Meta-...mentioning

confidence: 99%

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Bias and Accuracy of Glomerular Filtration Rate Estimating Equations in the US

Yan,

Williams,

Shi

et al. 2024

JAMA Netw Open

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ImportanceThere is increasing concern that continued use of a glomerular filtration rate (GFR) estimating equation adjusted for a single racial group could exacerbate chronic kidney disease-related disparities and inequalities.ObjectiveTo assess the performance of GFR estimating equations across varied patient populations.Data SourcesPubMed, Embase, Web of Science, ClinicalTrials.gov, and Scopus databases were systematically searched from January 2012 to February 2023.Study SelectionInclusion criteria were studies that compared measured GFR with estimated GFR in adults using established reference standards and methods. A total of 6663 studies were initially identified for screening and review.Data Extraction and SynthesisFollowing Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 2 authors independently extracted data on studies that examined the bias and accuracy of GFR estimating equations. For each outcome, a random-effects model was used to calculate pooled estimates. Data analysis was conducted from March to December 2023.Main Outcomes and MeasuresThe primary outcomes were bias and accuracy of estimated GFRs in Black vs non-Black patients, as well as in individuals with chronic conditions. Bias was defined as the median difference between the measured GFR and the estimated GFR. Accuracy was assessed with P30 (the proportion of persons in a data set whose estimated GFR values were within 30% of measured GFR values) and measures of heterogeneity.ResultsA total of 12 studies with a combined 44 721 patients were included. Significant heterogeneity was found in the bias of various GFR estimation equations. Race-corrected equations and creatinine-based equations tended to overestimate GFR in Black populations and showed mixed results in non-Black populations. For creatinine-based equations, the mean bias in subgroup analysis was 2.1 mL/min/1.73 m2 (95% CI, –0.2 mL/min/1.73 m2 to 4.4 mL/min/1.73 m2) in Black persons and 1.3 mL/min/1.73 m2 (95% CI, 0.0 mL/min/1.73 m2 to 2.5 mL/min/1.73 m2) in non-Black persons. Equations using only cystatin C had small biases. Regarding accuracy, heterogeneity was high in both groups. The overall P30 was 84.5% in Black persons and 87.8% in non-Black persons. Creatinine-based equations were more accurate in non-Black persons than in Black persons. For creatinine–cystatin C equations, the P30 was higher in non-Black persons. There was no significant P30 difference in cystatin C–only equations between the 2 groups. In patients with chronic conditions, P30 values were generally less than 85%, and the biases varied widely.Conclusions and RelevanceThis systematic review and meta-analysis of GFR estimating equations suggests that there is bias in race-based GFR estimating equations, which exacerbates kidney disease disparities. Development of a GFR equation independent of race is a crucial starting point, but not the sole solution. Addressing the disproportionate burden of kidney failure on Black individuals in the US requires an enduring, multifaceted approach that should include improving diagnostics, tackling social determinants of health, confronting systemic racism, and using effective disease prevention and management strategies.

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Performance of the race-free CKD-EPI creatinine-based eGFR equation in a Danish cohort with measured GFR

Munch,

Heide-Jørgensen,

Jensen

et al. 2023

Clinical Kidney Journal

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Background In 2021, an updated Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for estimated glomerular filtration rate (eGFR) without a coefficient for race (CKD-EPI21) was developed. The performance of this new equation has yet to be examined among specific patient groups. Methods We compared the performances of the new CKD-EPI21 equation and the 2009 equation assuming non-Black race (CKD-EPI09-NB) in patients with GFR measured by chromium-51-EDTA plasma clearance at Aarhus University Hospital in Denmark during 2010–2018. We examined bias, accuracy, precision, and correct classification of chronic kidney disease (CKD) stage using chromium-51-EDTA clearance as the reference standard. We assessed the performance in the total cohort, cancer patients, and potential living kidney donors. We also assessed the performance stratified by CKD stage in the total cohort. Results In this predominantly White population, the CKD-EPI21 equation performed slightly better than the CKD-EPI09-NB equation in both the total cohort (N = 4 668) and in cancer patients (N = 3 313) and potential living kidney donors (N = 239). In the total cohort, the CKD-EPI21 equation demonstrated a slightly lower median absolute bias (−0.2 versus −4.4 ml/min/1.73 m2), and a similar accuracy, precision, and correct classification of CKD stage compared with the CKD-EPI09-NB equation. When stratified by CKD stage, the CKD-EPI09-NB equation performed slightly better than the CKD-EPI21 equation among patients with a measured GFR <60 ml/min/1.73 m2. Conclusions In a selected cohort of Danish patients with measured GFR, the CKD-EPI21 equation performed slightly better than the CKD-EPI09-NB equation except for patients with a measured GFR <60 ml/min/1.73 m2 where CKD-EPI09-NB performed slightly better although the differences were considered clinically insignificant.

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GFR Estimation in Potential Living Kidney Donors: Race- and Nonrace-based Equations and Measured GFR

Cited by 6 publications

References 37 publications

Performance of estimated glomerular filtration rate equations in Black living kidney donor candidates

Performance of estimated glomerular filtration rate equations in Black living kidney donor candidates

Bias and Accuracy of Glomerular Filtration Rate Estimating Equations in the US

Performance of the race-free CKD-EPI creatinine-based eGFR equation in a Danish cohort with measured GFR

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