The Color of Kidneys

Martin, Toni

doi:10.1053/j.ajkd.2011.08.018

Cited by 11 publications

(8 citation statements)

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“…27 Third, there is genetic diversity within self-identified African-Americans. 28 Given potential issues for using race to estimate kidney function, we sought to examine the possible impact of the race multiplier term in the CKD-EPI equation on care delivery for African-Americans. Specifically, we focused on care delivery outcomes for advanced CKD patients, by leveraging a population-based database with detailed data on CKD care delivery measures.…”

Section: Introductionmentioning

confidence: 99%

Examining the Potential Impact of Race Multiplier Utilization in Estimated Glomerular Filtration Rate Calculation on African-American Care Outcomes

et al. 2020

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BACKGROUND: Advancing health equity entails reducing disparities in care. African-American patients with chronic kidney disease (CKD) have poorer outcomes, including dialysis access placement and transplantation. Estimated glomerular filtration rate (eGFR) equations, which assign higher eGFR values to African-American patients, may be a mechanism for inequitable outcomes. Electronic health record-based registries enable population-based examination of care across racial groups. OBJECTIVE: To examine the impact of the race multiplier for African-Americans in the CKD-EPI eGFR equation on CKD classification and care delivery. DESIGN: Cross-sectional study SETTING: Two large academic medical centers and affiliated community primary care and specialty practices. PARTICIPANTS: A total of 56,845 patients in the Partners HealthCare System CKD registry in June 2019, among whom 2225 (3.9%) were African-American. MEASUREMENTS: Exposures included race, age, sex, comorbidities, and eGFR. Outcomes were transplant referral and dialysis access placement. RESULTS: Of 2225 African-American patients, 743 (33.4%) would hypothetically be reclassified to a more severe CKD stage if the race multiplier were removed from the CKD-EPI equation. Similarly, 167 of 687 (24.3%) would be reclassified from stage 3B to stage 4. Finally, 64 of 2069 patients (3.1%) would be reassigned from eGFR > 20 ml/min/1.73 m 2 to eGFR ≤ 20 ml/min/ 1.73 m 2 , meeting the criterion for accumulating kidney transplant priority. Zero of 64 African-American patients with an eGFR ≤ 20 ml/min/1.73 m 2 after the race multiplier was removed were referred, evaluated, or waitlisted for kidney transplant, compared to 19.2% of African-American patients with eGFR ≤ 20 ml/min/1.73 m 2 with the default CKD-EPI equation.LIMITATIONS: Single healthcare system in the Northeastern United States and relatively small African-American patient cohort may limit generalizability. CONCLUSIONS: Our study reveals a meaningful impact of race-adjusted eGFR on the care provided to the African-American CKD patient population.

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Section: Introductionmentioning

confidence: 99%

Examining the Potential Impact of Race Multiplier Utilization in Estimated Glomerular Filtration Rate Calculation on African-American Care Outcomes

et al. 2020

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“…Similar concerns about the limitations of the race coefficient used in North America have been recently raised. 11 A potential limitation of our study is the use of iohexol clearance as the formal GFR measurement. 8 The study was designed with respect to what is practical and achievable in very remote regions of Australia.…”

mentioning

confidence: 98%

Accurate Assessment of Kidney Function in Indigenous Australians: The Estimated GFR Study

Maple-Brown

Hughes

Lawton

et al. 2012

American Journal of Kidney Diseases

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“…In 2011, physician Toni Martin published a commentary expressing the psychological impacts of the race multiplier on their Black and nonwhite patients (Martin, 2011). Since then, there has been a continued tide of published commentary of the equations.…”

Section: Galton?mentioning

confidence: 99%