Evaluating the Impact and Rationale of Race-Specific Estimations of Kidney Function: Estimations from U.S. NHANES, 2015-2018.

Background: Standard equations for estimating glomerular filtration rate (eGFR) employ race multipliers, systematically inflating eGFR for Black patients. Such inflation is clinically significant because eGFR thresholds of 60, 30, and 20 ml/min/1.73m ² guide kidney disease management. Racialized adjustment of eGFR in Black Americans may thereby affect their clinical care. In this study, we analyze and extrapolate national data to assess potential impacts of the eGFR race adjustment on qualification for kidney disease diagnosis, nephrologist referral, and transplantation listing.
Methods: Using population-representative cross-sectional data from the United States National Health and Nutrition Examination Survey (NHANES) from 2015-2018, eGFR values for Black Americans were calculated using the Modification of Diet in Renal Disease (MDRD) equation with and without the 1.21 race-specific coefficient using cohort data on age, sex, race, and serum creatinine.
Findings: Without the MDRD eGFR race adjustment, 3.3 million (10.4%) more Black Americans would reach a diagnostic threshold for Stage 3 Chronic Kidney Disease, 300,000 (0.7%) more would qualify for beneficial nephrologist referral, and 31,000 (0.1%) more would become eligible for transplant evaluation and waitlist inclusion.
Interpretation: These findings suggest eGFR race coefficients may contribute to racial differences in the management of kidney. We provide recommendations for addressing this issue at institutional and individual levels.
Funding: No external funding was received for this study.
Competing Interests: Author JPC acknowledges support from the National Institutes of Health Medical Scientist Training Program Grant T32GM136651 and the Robert Wood Johnson Health Policy Research Scholars Program. Author WSA has previously acted as a site principal investigator, with fees paid to the institution, for Novartis, Medeor Therapeutics, Amplyx Therapeutics, and InRegen. WSA also serves on the education committee for the American Society of Transplantation. Author MLM previously consulted for BayerAG in 2020. Author VG has previously received payment for educational work for Akebia Pharmaceuticals, the University of New Mexico, Alameda Health System, and the University of Illinois Chicago.
(© 2021 The Author(s).)