Race and the False Precision of Glomerular Filtration Rate Estimates
Authors: Ashwini R. Sehgal
Journal: Annals of Internal Medicine (2020)

Ideas and Opinions15 December 2020Race and the False Precision of Glomerular Filtration Rate EstimatesAshwini R. Sehgal, MDAshwini R. Sehgal, MDCase Western Reserve University, Cleveland, Ohio (A.R.S.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-4951 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Quantifying glomerular filtration rate (GFR), a key measure of kidney function, is important for both the management and prognosis of kidney disease. Glomerular filtration rate is expressed in milliliters per minute normalized to body surface area, and values below 60, 30, and 15 mL/min/1.73 m2 correspond to a mild to moderate decrease in function, a severe decrease in function, and kidney failure, respectively. Using an exogenous marker, such as iothalamate, is the gold standard for measuring GFR but is not a routine practice. Instead, GFR is estimated by taking advantage of the endogenous marker creatinine. Serum creatinine levels reflect a ...References1. Levey AS, Stevens LA, Schmid CH, et al; CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150:604-12 LinkGoogle Scholar2. Grubbs V. Precision in GFR reporting: let's stop playing the race card [Editorial]. Clin J Am Soc Nephrol. 2020. [PMID: 32401730] doi:10.2215/CJN.00690120 CrossrefMedlineGoogle Scholar3. Eneanya ND, Yang W, Reese PP. Reconsidering the consequences of using race to estimate kidney function. JAMA. 2019;322:113-114. [PMID: 31169890] doi:10.1001/jama.2019.5774 CrossrefMedlineGoogle Scholar4. Levey AS, Titan SM, Powe NR, et al. Kidney disease, race, and GFR estimation. Clin J Am Soc Nephrol. 2020. [PMID: 32393465] doi:10.2215/CJN.12791019 CrossrefMedlineGoogle Scholar5. Feldman HI, Appel LJ, Chertow GM, et al; Chronic Renal Insufficiency Cohort (CRIC) Study Investigators. The Chronic Renal Insufficiency Cohort (CRIC) study: design and methods. J Am Soc Nephrol. 2003;14:S148-53. [PMID: 12819321] CrossrefMedlineGoogle Scholar6. Vyas DA, Eisenstein LG, Jones DS. Hidden in plain sight — reconsidering the use of race correction in clinical algorithms. N Engl J Med. 2020. doi:10.1056/NEJMms2004740 CrossrefGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Case Western Reserve University, Cleveland, Ohio (A.R.S.)Grant Support: By grants MD002265 and DK112905 from the National Institutes of Health.Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-4951.Corresponding Author: Ashwini R. Sehgal, MD, Division of Nephrology, Center for Reducing Health Disparities, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109; e-mail, [email protected]edu.Author Contributions: Conception and design: A. Sehgal.Analysis and interpretation of the data: A. Sehgal.Drafting of the article: A. Sehgal.Critical revision for important intellectual content: A. Sehgal.Final approval of the article: A. Sehgal.Statistical expertise: A. Sehgal.Obtaining of funding: A. Sehgal.Administrative, technical, or logistic support: A. Sehgal.Collection and assembly of data: A. Sehgal.This article was published at Annals.org on 18 August 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals On Call - Should Race Be Part of Glomerular Filtration Rate Estimation? Robert M. Centor and Ashwini R. Sehgal Annals On Call - Estimating Glomerular Filtration Rate Robert M. Centor and Neil R. Powe Metrics Cited by2009 CKD-EPI glomerular filtration rate estimation in Black individuals outside the United States: a systematic review and meta-analysisNational Projections for Clinical Implications of Race-Free Creatinine-Based GFR Estimating EquationsRemoving race from the CKD-EPI equation and its impact on prognosis in a predominantly White European populationThe Role of Race on Acute Kidney Injury After Cardiac SurgeryAccuracy evaluation of 2021 Chronic Kidney Disease Epidemiology Collaboration, Full Age Spectrum and European Kidney Function Consortium equations for estimating glomerular filtration rate in type 2 diabetes mellitus and healthy adultsQuantifying Individual-Level Inaccuracy in Glomerular Filtration Rate Estimation A Cross-Sectional StudyTariq Shafi, MBBS, MHS, Xiaoqian Zhu, PhD, Seth T. Lirette, PhD, Andrew D. Rule, MD, Thomas Mosley, PhD, Kenneth R. Butler, PhD, Michael E. Hall, MD, MS, Pradeep Vaitla, MD, James J. 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Inker, MD, MSClinical Implications of Removing Race From Estimates of Kidney FunctionRemoval of Race From Estimates of Kidney FunctionRace, science and (im)precision medicine 15 December 2020Volume 173, Issue 12Page: 1008-1009KeywordsCreatinineEstimated glomerular filtration rateGlomerular filtration rateKidneysMusclesNephrologyNutritionRacial and ethnic issuesRenal diseasesRenal failure ePublished: 18 August 2020 Issue Published: 15 December 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...