The « race » correction in estimating glomerular filtration rate: an European point of view

Abstract

Purpose of review There is currently a heated debate ongoing whether or not to use the race coefficient for black people in the Modification of Diet in Renal Diseases and Chronic Kidney Disease Epidemiology-equation. The use of the race coefficient is thought by several American authors as a source of discrimination. Recent findings It has recently been shown that the race coefficient is inaccurate in European and African black people. Therefore, it seems that the race correction is more a correction for black Americans, rather than for black in general. This ‘correction’ at the glomerular filtration rate (GFR)-level has been criticized, as it is misleading, and should be abandoned, as it has not been shown that GFR is different between black and white people. However, as differences in creatinine generation between black and white people might exist, a correction or adjustment, different for black and white people, at the creatinine level might be required, very similar to the different scaling of creatinine for males and females. Summary The current debate on the race coefficient is particularly difficult because of the absence of good scientific data in black subjects and there lies the real discrimination in our opinion. We therefore call for future dedicated studies, both in Europe and USA.

Point of care creatinine derived eGFR measurement in capillary blood for identifying patients at risk

“…P values < 0.05 were considered significant. Because we measured GFR in an european population, we never use race correction explaining we focused on previous CKDEPI equation to perform Passing-Bablok regression and Bland-Altman plots (used to show the agreement between mGFR and eGFR) [ 16 ].…”

Americentrism in estimation of glomerular filtration rate equations

“…First, good reasons exist to suggest that the "race" coefficient used in the seminal MDRD and CKD-EPI equations was inaccurate in Black healthy subjects, because very few healthy Black people were used in the development database. 4 Second, the coefficient was also probably questionable, in terms of performance, in Black women. 4 This point has been largely understudied, but the societal impact of inaccurate GFR estimation in Black women deserves more extensive investigation.…”

“…4 Second, the coefficient was also probably questionable, in terms of performance, in Black women. 4 This point has been largely understudied, but the societal impact of inaccurate GFR estimation in Black women deserves more extensive investigation. In the Multi-Ethnic Study of Atherosclerosis, the CKD-EPI equation was particularly poor in Black American women (with a bias leading to overestimation of 16.4 ml/min per 1.73 m 2 and an accuracy within 30% of only 65.7%).…”

“…Third, both MDRD and CKD-EPI equations were adjusted, correcting for race at the GFR level, which artificially emphasizes the questionable impact, as measured GFR is not influenced by race, but serum creatinine is influenced by populationdependent factors (e.g., age, sex, and race; see Figure 1). 4 The European Kidney Function Consortium (EKFC), with a Euro-centric focus, has recently proposed an eGFR equation where the variable "creatinine" is normalized by "normal median creatinine," named the Q value, as established in dedicated populations (with separated Q values for the most important variables influencing serum creatinine; i.e., sex). 2 The word "population" is important, and this is not hypocritical semantic.…”

“…1 In the seminal MDRD and CKD-EPI equations, the race coefficient was established for "Black people". Beyond the facts that race is a social construct (without any biological justification) and that skin color does not influence GFR or serum creatinine in a biological 4 The debate on the race coefficient in America has led to the publication of a new creatinine-based equation without the race variable. 1 Because there is a difference in the relationship between creatinine and GFR in Black and White Americans, the new equation was designed to be equally biased by race, but in opposite direction.…”