Both the nephrology and larger medical community is reexamining the use of the race-based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for estimating glomerular filtration rate (eGFR). According to new data published in JAMA Network Open, removal of the coefficient for Black race from the CKD-EPI equation will reclassify substantial numbers of Black individuals in the United States as having stage 3 or higher CKD.1
Investigators led by Rajiv Saran, MBBS, MD, MS, of the University of Michigan in Ann Arbor, Michigan, studied 2 contemporary national cohorts of Black adults: a representative sample of 9682 individuals self-identifying as Black who participated in the National Health and Nutrition Examination Surveys (NHANES) from 1999 to 2018 and 786,718 Black veterans from the Veterans Affairs Health System from 2018.
In the general US Black population (mean age 44 years, 44% male), mean eGFR decreased from 102.8 mL/min/1.73 m2 using the CKD-EPI equation with the Black race coefficient to 88.1 mL/min/1.73 m2 using the CKD-EPI equation without the coefficient. Among the Black veterans (mean age 58.1 years; 84% male), mean eGFR decreased from 82.9 to 71.6 mL/min/1.73 m2, respectively..
Among Black adults in the general population, elimination of the race coefficient increased the prevalence of individuals with CKD (eGFR of less than 60 mL/min/1.73 m2) from 5.8% to 10.4%, Dr Saran’s team reported. Based on sample weighting, an additional 981,038 Black individuals with purportedly higher kidney function would be reclassified as having stage 3 CKD and 67,957 Black adults with stage 3 disease would be reclassified as having stage 4 or 5 CKD.
Among Black veterans, CKD prevalence increased from 15.5% to 26.3% with elimination of the race coefficient, with an additional 84,988 being diagnosed with stage 3 disease and 6253 being reclassified from stage 3 to stage 4 or 5 CKD, the investigators reported.
“A rigorous examination of the consequences of this large, expected shift in the estimated burden of CKD is required, with sensitivity to individual patient perspectives and public health considerations to minimize the possibility of unintended harm,” according to Dr Saran and his colleagues.
To that end, the National Kidney Foundation and American Society of Nephrology formed a joint task force last year to examine the inclusion of race in the estimation of GFR and its implications for the diagnosis and management of patients with, or at risk for, kidney diseases.2 The task force is actively soliciting input from clinicians, patients, and other interested parties.
“Our findings suggest that continuing research to improve current GFR estimating equations using race-neutral biomarkers should be given high priority,” Dr Saran’s team concluded.
- Bragg-Gresham J, Zhang X, Le D, et al. Prevalence of chronic kidney disease among black individuals in the US after removal of the black race coefficient from a glomerular filtration rate estimating equation. JAMA Netw Open. 2021;4(1):e2035636. doi:10.1001/jamanetworkopen.2020.35636
- NKF and ASN form joint task force to focus on use of race in eGFR. ASN Kidney News; August 24, 2020.