The Case Against Race-Based GFR

Uppal, Prabhdeep; Golden, Benjamin L; Panicker, Ashley; Khan, Omar A.; Burday, Matthew J.

doi:10.32481/djph.2022.014

Cited by 8 publications

(12 citation statements)

References 10 publications

(12 reference statements)

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“…Additionally, works to validate the change have been implemented and used as evidence to support the positivity of using the 2021 CKD-EPI equation. 51,9,52,10,53 The present study aimed to understand whether using the 2021 CKD-EPI equation led to decreased disparity between Black patients and their counterparts with regards to how quickly they should have been diagnosed with CKD. We also aimed to find whether there was discordance in the staging at diagnosis for Black patients compared to their counterparts.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, works to validate the change have been implemented and used as evidence to support the positivity of using the 2021 CKD-EPI equation. 51, 9, 52, 10, 53…”

Section: Discussionmentioning

confidence: 99%

“…8, 9 The inclusion of a race adjustment in the equations for CKD were based on the assumption that Black people have a higher muscle mass, than other racial groups 9 and therefore should have a higher baseline serum creatinine level. 10 In practice, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2009 GFR estimation equation included a multiplier of −1.157 that resulted in a lower GFR calculation (indicating higher kidney function) in Black patients than in other racial groups with similar input values for creatinine. The National Kidney Foundation and American Society of Nephrology (NKF-ASN) Task Force recommended changes to the determination for GFR in the United States; “[t]here is no evidentiary basis for keeping a race coefficient in the eGFR calculation”) or to reinforce racial bias by including race in the calculation but remove it during clinical reporting of GFR.…”

Section: Introductionmentioning

confidence: 99%

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Effects of changes in calculating GFR using KDIGO standards: Discordance in the Staging and Timing of Diagnosis of Chronic Kidney Disease

Baker,

Gratzl,

Rodriguez

et al. 2024

Preprint

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IntroductionChronic kidney disease (CKD) is a highly prevalent disease with disparities in diagnosis and treatment. Until recently, primary diagnosis for CKD was based on equations that incorporated race and have demonstrated racial bias. This study had two aims comparing outcomes for Black patients and their counterparts: 1) whether using the new 2021 CKD-EPI equation led to decreased disparity with time to diagnosis; and 2) whether there was discordance in the staging between the two equations at potential diagnosis point.MethodsWe evaluated patients aged 18 and over with non-hospitalization related serum creatinine laboratory results between January 1, 2016 and September 30, 2023. We estimated the GFR for each patient using the 2009 and 2021 CKD-EPI creatinine equations. We assessed stage discordance for stages 3a, 3b, 4, and 5 using chi-square tests and the Cochran-Mantel-Haenszel. We used multivariate logistic regression to assess a change in staging based on the equation used.Results15.5% of the 8,080,889 patients included in this study were Black. The median age was 57 years and 15.3% of patients met the criteria for stage 3a CKD or higher using either equation. Discordance in staging by equation and by race existed, especially for Black patients at stages 3a and 3b. 40% of Black patients identified as stage 4 using the 2021 equation were 3b or lower using the 2009 equation.DiscussionWell established medical algorithms with race components are being re-examined. We found more disparity with the initial staging of the disease. The disconnect in the timing of staging by equation for Black patients means a number of these patients may not have received the appropriate treatment. Future work should elucidate the impact of the change in CKD staging with the 2021 CKD-EPI creatinine equation on treatment.ConclusionSignificant disparity exists in the timing and staging of CKD by CKD-EPI equation and by race.

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Section: Discussionmentioning

confidence: 99%

“…Additionally, works to validate the change have been implemented and used as evidence to support the positivity of using the 2021 CKD-EPI equation. 51, 9, 52, 10, 53…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects of changes in calculating GFR using KDIGO standards: Discordance in the Staging and Timing of Diagnosis of Chronic Kidney Disease

Baker,

Gratzl,

Rodriguez

et al. 2024

Preprint

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“…The 2021 CKD-EPI formula is a race-free formulae that has been widely used to assess renal insufficiency among Africans in SSA [ 11 , 12 ]. Use of race-based CKD-EPI has been shown to overestimate eGFR if applied among African populations, consequently resulting in delayed initiation of nephrological care including dialysis initiation [ 31 , 32 , 33 ]. The eGFR values were also categorized according to the KDIGO 2012 Clinical Practice Guideline [ 30 ].…”

Section: Methodsmentioning

confidence: 99%

Prevalence and Risk Factors for Renal Insufficiency among Adults Living with HIV in Tanzania: Results from a Cross-Sectional Study in 2020–2021

Ottaru,

Kwesigabo,

Butt

et al. 2024

Healthcare

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With improved survival, adults living with HIV (ALHIV) are increasingly likely to experience age-related and HIV-related comorbidities, including renal insufficiency. Other risk factors for renal insufficiency (high blood pressure (BP), obesity, diabetes, and dyslipidemia) are also growing more common among ALHIV. To determine the prevalence of renal insufficiency (defined as an eGFR < 60 mL/min/1.73 m2) and factors associated with reduced eGFR, we conducted a cross-sectional study at six HIV clinics in Dar-es-Salaam, Tanzania. We applied multivariable (MV) ordinal logistic regression models to identify factors associated with reduced eGFR and examined the interaction of age with BP levels. Among the 450 ALHIV on ART analyzed [26% males; median age 43 (IQR: 18–72) years; 89% on tenofovir-containing ART; 88% HIV viral load ≤50 copies/mL], 34 (7.5%) had renal insufficiency. Prevalence was higher among males (12%) vs. females (6%), p = 0.03; ALHIV ≥50 (21%) vs. <50 years (2.5%), p < 0.001; those with high [≥130/80 mmHg (15%)] vs. normal [<120/80 mmHg (4%)] BP, p < 0.01 and those with dyslipidemia (10%) vs. those without (4.5%), p < 0.03. After adjusting for covariates, age (in years) was the only covariate with a statistically significant association with reduced eGFR (OR = 1.09 (1.07–1.12), p < 0.001). No significant interaction between age and BP was found. Interventions to increase routine screening for renal insufficiency, especially among older ALHIV, and improve BP control are critical to reducing kidney disease-related morbidity and mortality.

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“…When medical training leaves physicians with the idea that substantive genetic differences exist between races, this facilitates the implicit and explicit rationalization and justification of treating patients differently based on their race. This ultimately causes harm to individuals as it can result in alarming outcomes such as the administration of less pain medications due to false beliefs of racially-linked differences in pain tolerance ( Hoffman et al, 2016 ), fewer preventative screenings for bone density measurements in Black women, the ultilization of race-adjusted glomerular filtration rate to assess kidney function which results in underdiagnosis of kidney disease in Black patients ( Ahmed et al, 2021 ; Uppal et al, 2022 ), and many more examples. Additionally, attributing racial health disparities based on the false premise of racially-based genetic differences conflates the cause and the effect of health disparities and detracts from examining the underlying problems driving these differences, such as racism and systemic inequality.…”

Section: Introductionmentioning

confidence: 99%

The use of race terms in epigenetics research: considerations moving forward

King,

Lalwani,

Mercado

et al. 2024

Front. Genet.

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The field of environmental epigenetics is uniquely suited to investigate biologic mechanisms that have the potential to link stressors to health disparities. However, it is common practice in basic epigenetic research to treat race as a covariable in large data analyses in a way that can perpetuate harmful biases without providing any biologic insight. In this article, we i) propose that epigenetic researchers open a dialogue about how and why race is employed in study designs and think critically about how this might perpetuate harmful biases; ii) call for interdisciplinary conversation and collaboration between epigeneticists and social scientists to promote the collection of more detailed social metrics, particularly institutional and structural metrics such as levels of discrimination that could improve our understanding of individual health outcomes; iii) encourage the development of standards and practices that promote full transparency about data collection methods, particularly with regard to race; and iv) encourage the field of epigenetics to continue to investigate how social structures contribute to biological health disparities, with a particular focus on the influence that structural racism may have in driving these health disparities.

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The Case Against Race-Based GFR

Cited by 8 publications

References 10 publications

Effects of changes in calculating GFR using KDIGO standards: Discordance in the Staging and Timing of Diagnosis of Chronic Kidney Disease

Effects of changes in calculating GFR using KDIGO standards: Discordance in the Staging and Timing of Diagnosis of Chronic Kidney Disease

Prevalence and Risk Factors for Renal Insufficiency among Adults Living with HIV in Tanzania: Results from a Cross-Sectional Study in 2020–2021

The use of race terms in epigenetics research: considerations moving forward

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