Racial Disparities in Creatinine-based Kidney Function Estimates Among HIV-infected Adults

Anker, Naomi; Scherzer, Rebecca; Peralta, Carmen A.; Powe, Neil R.; Banjeree, Tanushree; Shlipak, Michael G.

doi:10.18865/ed.26.2.213

Cited by 12 publications

(8 citation statements)

References 35 publications

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“…21 Previous data from Africa (and African European) also suggested that such an ethnic factor was not valuable. [18][19][20][21][22]29,30 Regarding ethnicity, we showed that FAS SCr af had the same global performance as FAS SCr observed in Whites, both in patients with low GFR values and in subjects with high GFR values. This is easily explained, as Q af was not different from the Q values observed in Whites.…”

Section: Discussionsupporting

confidence: 51%

Performance of creatinine- or cystatin C–based equations to estimate glomerular filtration rate in sub-Saharan African populations

Bukabau

Yayo

Gnionsahé

et al. 2019

Kidney International

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Glomerular filtration rate (GFR) is the best index for kidney function; however, the applicability of GFR estimating equations in sub-Saharan African populations remains unclear. In a cross-sectional study of adults living in Kinshasa, Democratic Republic of Congo (n[210) and Abidjan, Ivory Coast (n[284), we evaluated the performance of creatinine and cystatin C-based equations using plasma clearance of iohexol as the reference standard. The race coefficient did not improve the performance of creatinine-based GFR estimates; in fact, both the Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology (CKD-EPI) equations performed better without the race coefficient in participants with GFR ‡60 mL/min/1.73m 2. The CKD-EPI and Full Age Spectrum (FAS) equations were unbiased and had similar precision (SD of 17.9 versus 19 mL/min/1.73 m 2) and accuracy within 30% (P30, 86.7% versus 87.4%) in participants with GFR ‡60 mL/min/1.73m 2. Both equations performed poorly in the subgroup with measured GFR < 60 mL/min/1.73m 2 (n[80), but the FAS equation had smaller bias (L4.8 mL/min/1.73m 2 versus L7.7 mL/min/1.73m 2 for CKD-EPI) and higher P30 (56.3% versus 31.3% for CKD-EPI). The corresponding equations including cystatin C alone or in combination with creatinine had similar performance. In a sub-Saharan African population, adjustment for race did not improve the performance of GFR estimating equations. The creatinine-based FAS and CKD-EPI equations performed reasonably well and were comparable when GFR was ‡ 60 mL/min/1.73m 2. Cystatin C did not improve performance. The FAS equation may be preferable when GFR is < 60 mL/min/1.73m 2 , but this should be confirmed in larger studies.

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Section: Discussionsupporting

confidence: 51%

Performance of creatinine- or cystatin C–based equations to estimate glomerular filtration rate in sub-Saharan African populations

Bukabau

Yayo

Gnionsahé

et al. 2019

Kidney International

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“…Glomerular filtration rate (GFR) was estimated using the 4-variable MDRD (Modification of Diet in Renal Disease) Study 20 and CKD-EPI (CKD Epidemiology Collaboration) 21 equations. The MDRD Study and CKD-EPI equations without the race factor were used for estimating GFR in this study given that recent studies [22][23][24] have suggested that the inclusion of race may generate less precise estimates in the black population. For computations requiring estimated GFR, values from the CKD-EPI equation were used.…”

Section: Ethical Approvalmentioning

confidence: 99%

Association of Genetic Polymorphisms of TGF-β1, HMOX1, and APOL1 With CKD in Nigerian Patients With and Without HIV

Ekrikpo

Mnika

Effa

et al. 2020

American Journal of Kidney Diseases

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“…Previous studies have identified differences between renal function estimates among Black patients. 12,[16][17][18][19][20][21] Booysen et al 20 and Omuse et al 17 reported that CKD-EPI was the most accurate estimate in Black South Africans and Kenyans, respectively. However, Eastwood et al 18 determined that CKD-EPI without race was more accurate in lean Black patients in Ghana.…”

Section: Discussionmentioning

confidence: 99%

“…We included patients with or without CKD, and in a subgroup analysis by CKD stage, we found the highest rate of discordance in patients with CKD stage 4. Anker et al 19 performed a large cohort study in the Department of Veteran Affairs HIV Clinics, which included 12 029 Black patients. They reported that whereas the mean measured GFR in Black patients was only 6.6% higher when compared with White patients, the eGFR calculated by the CKD-EPI equation was 16% higher in Black patients than in White patients.…”

Section: Discussionmentioning

confidence: 99%

Impact of Removing the Race Coefficient in Renal Function Estimate Equations on Drug Dosage Recommendations

Miller

Knorr

2021

Ann Pharmacother

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Background The appropriateness of including the race coefficient in glomerular filtration rate (GFR) equations in Black patients is debated, and the impact on drug dosing is unknown. Objective This study explored the impact of removing the race coefficient on drug dosing in Black patients in comparison to conventional methods. Methods This was a retrospective study of hospitalized patients who self-identified as Black/African American and were prescribed an antimicrobial that includes renal dosage recommendations in the product labeling. The primary end point was the discordance between drug dosing recommendations derived by body surface area deindexed GFR estimated by the CKD-EPI equation (Chronic Kidney Disease Epidemiology study) with and without race versus recommendations derived from Cockcroft-Gault (CG). Results A total of 210 Black patients were included. There was an 18% rate of discordance when GFR was estimated with the race coefficient (GFR w/Race) versus without the race coefficient (GFR w/out Race). GFR w/out Race had a higher level of agreement with dosing by creatinine clearance (CrCl; κ = 0.779) than GFR w/Race versus CrCl (κ = 0.651). GFR w/out Race had less within-patient difference than GFR w/Race in comparison to CrCl (mean difference: −6.3 vs −18.0 mL/min). Conclusions and Relevance This represents the first report to examine the removal of the race coefficient and its implication on drug dose discordance. GFR w/out Race had a higher level of agreement and less drug dose discordance than GFR w/Race, in comparison to CrCl estimates. If GFR equations are considered comparable to CrCl for the purposes of guiding drug dosing, GFR w/out Race should be considered.

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Racial Disparities in Creatinine-based Kidney Function Estimates Among HIV-infected Adults

Cited by 12 publications

References 35 publications

Performance of creatinine- or cystatin C–based equations to estimate glomerular filtration rate in sub-Saharan African populations

Performance of creatinine- or cystatin C–based equations to estimate glomerular filtration rate in sub-Saharan African populations

Association of Genetic Polymorphisms of TGF-β1, HMOX1, and APOL1 With CKD in Nigerian Patients With and Without HIV

Impact of Removing the Race Coefficient in Renal Function Estimate Equations on Drug Dosage Recommendations

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