Race-adjusted eGFR may negatively affect CKD care in African American patients

A cross-sectional registry study found that one-third of African American patients with chronic kidney disease (CKD) would hypothetically be reclassified to a more severe stage if the race multiplier were removed from a common estimated glomerular filtration rate (eGFR) equation.

The severity of chronic kidney disease (CKD) in African American patients may be underestimated when equations to calculate estimated glomerular filtration rate (eGFR) are adjusted for race, according to a recent study.

Researchers performed a cross-sectional study using data from a CKD registry at two academic medical centers and affiliated primary and specialty care practices in Massachusetts to look at the effect of the race multiplier in the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) eGFR equation on disease classification and delivery of care in African American patients. Race, age, sex, comorbid conditions, and eGFR were analyzed, and outcome measures were transplant referral and dialysis access placement. The results were published Oct. 15 by the Journal of General Internal Medicine.

The study included 56,845 patients with CKD, of whom 2,225 (3.9%) were African American. Of these 2,225 patients, the researchers determined that 743 (33.4%) would hypothetically be reclassified to a more severe stage of CKD if the race multiplier were removed from the CKD-EPI equation. Likewise, 167 of 687 African American patients (24.3%) would be reclassified from stage 3B to stage 4 disease, and 64 of 2,069 Black patients (3.1%) would be reassigned from an eGFR greater than 20 mL/min/1.73 m2 to an eGFR of 20 mL/min/1.73 m2 or lower, which meets the threshold for accumulating kidney transplant priority, the authors noted. None of 64 African American patients whose eGFR was 20 mL/min/1.73 m2 or less after removal of the race multiplier had been referred, evaluated, or waitlisted for kidney transplant, versus 19.2% (30 of 156) whose eGFR was 20 mL/min/1.73 m2 or lower with the default CKD-EPI equation.

The researchers noted that the generalizability of their study may be limited because it involved only one health system and a relatively small number of African American patients. They concluded that use of race-adjusted eGFR equations may be contributing to health disparities among CKD patients and called for further study of this issue. “Based on our findings, use of racial correction in eGFR can potentially impact care for African-American patients with advanced CKD,” they wrote. “Considering the evidence of this unfavorable impact on care delivery for African-Americans, use of the eGFR race correction factor needs to be reconsidered and, at a minimum, providers should be transparent about its use.”