Should Estimated Glomerular Filtration Rate Be Adjusted for Race?

Cohen, Brian J.

doi:10.1002/cpdd.1030

Cited by 1 publication

(1 citation statement)

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“…These articles also declared that the race correction: 5) lacked a physiological explanation [ 10 , 25 - 27 , 29 - 31 , 37 , 40 , 42 , 43 , 45 , 49 , 57 , 58 , 60 , 62 , 70 ]; 6) was invalid because it did not apply to non-US Blacks [ 10 , 25 , 29 , 30 , 31 , 44 , 46 , 50 , 52 , 63 , 66 - 69 ]; 7) was due to diet, sociological effects and racism [ 10 , 13 , 19 , 25 , 31 , 37 , 40 , 42 , 44 , 46 , 49 , 68 ]; 8) was inconsistent with the greater incidence of end-stage renal disease (ESRD) in Blacks vis-à-vis Whites [ 10 , 40 , 45 , 58 ]; 9) was originally based on inadequate non-representative samples [ 25 , 40 , 42 , 46 , 52 , 53 , 63 , 68 ]; 10) was an ecological fallacy [ 10 , 34 , 35 ]; 11) was negligible relative to the measurement precision of eGFR cr [ 33 , 35 , 54 , 64 ]; and 12) was discriminatory because it denies CKD treatment to Blacks who would otherwise qualify [ 10 , 26 , 27 - 32 ,…”

Section: Reviewmentioning

confidence: 99%

Retaining Race in Chronic Kidney Disease Diagnosis and Treatment

Williams

2023

Cureus

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The best overall measure of kidney function is glomerular filtration rate (GFR) as commonly estimated from serum creatinine concentrations (eGFR cr ) using formulas that correct for the higher average creatinine concentrations in Blacks. After two decades of use, these formulas have come under scrutiny for estimating GFR differently in Blacks and non-Blacks. Discussions of whether to include race (Black vs. non-Black) in the calculation of eGFR cr fail to acknowledge that the original race-based eGFR cr provided the same CKD treatment recommendations for Blacks and non-Blacks based on directly (exogenously) measured GFR. Nevertheless, the National Kidney Foundation and the American Society of Nephrology Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease removed race in CKD treatment guidelines and pushed for the immediate adoption of a race-free eGFR cr formula by physicians and clinical laboratories. This formula is projected to negate CKD in 5.51 million White and other non-Black adults and reclassify CKD to less severe stages in another 4.59 million non-Blacks, in order to expand treatment eligibility to 434,000 Blacks not previously diagnosed and to 584,000 Blacks previously diagnosed with less severe CKD. This review examines: 1) the validity of the arguments for removing the original race correction, and 2) the performance of the proposed replacement formula. Excluding race in the derivation of eGFR cr changed the statistical bias from +3.7 to -3.6 ml/min/1.73m 2 in Blacks and from +0.5 to +3.9 in non-Blacks, i.e., promoting CKD diagnosis in Blacks at the cost of restricting diagnosis in non-Blacks. By doing so, the revised eGFR cr greatly exaggerates the purported racial disparity in CKD burden. Claims that the revised formulas identify heretofore undiagnosed CKD in Blacks are not supported when studies that used kidney failure replacement therapy and mortality are interpreted as proxies for baseline CKD. Alternatively, a race-stratified eGFR cr (i.e., separate equations for Blacks and non-Blacks) would provide the least biased eGFR cr for both Blacks and non-Blacks and the best medical treatment for all patients.

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Section: Reviewmentioning

confidence: 99%

Retaining Race in Chronic Kidney Disease Diagnosis and Treatment

Williams

2023

Cureus

View full text Add to dashboard Cite

show abstract

Should Estimated Glomerular Filtration Rate Be Adjusted for Race?

Cited by 1 publication

References 57 publications

Retaining Race in Chronic Kidney Disease Diagnosis and Treatment

Retaining Race in Chronic Kidney Disease Diagnosis and Treatment

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