Eliminating Racial Inequities in Kidney Health: Much More Than Revising Estimating Equations
Authors: Akinlolu Ojo
Journal: Annals of Internal Medicine (2022)

EditorialsMarch 2022Eliminating Racial Inequities in Kidney Health: Much More Than Revising Estimating EquationsAkinlolu Ojo, MD, PhD, MBAAkinlolu Ojo, MD, PhD, MBAUniversity of Kansas Medical Center, Kansas City, KansasSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M21-4875 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical laboratories in the United States and worldwide have adopted the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations for estimating glomerular filtration rate (GFR) in the clinical management of patients with CKD. Among their uses, the CKD-EPI equations are a clinical decision tool for preemptive placement on the kidney transplant waitlist before the initiation of maintenance dialysis, medication dosing, and referral for dialysis or a kidney transplant. These equations were developed and rigorously validated using isotopic GFR measurements as the comparator standard.In the developmental statistical modeling, the inclusion of a term for “Black race” improved model accuracy by 14% ...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. [PMID: 19414839] LinkGoogle Scholar2. Panchal S, Serper M, Bittermann T, et al. Impact of race-adjusted glomerular filtration rate estimation on eligibility for simultaneous liver-kidney transplantation. Liver Transpl. 2021. [PMID: 34558791] doi:10.1002/lt.26310 CrossrefMedlineGoogle Scholar3. Ahmed S, Nutt CT, Eneanya ND, et al. Examining the potential impact of race multiplier utilization in estimated glomerular filtration rate calculation on African-American care outcomes. J Gen Intern Med. 2021;36:464-71. [PMID: 33063202] doi:10.1007/s11606-020-06280-5 CrossrefMedlineGoogle Scholar4. Inker LA, Eneanya ND, Coresh J, et al; Chronic Kidney Disease Epidemiology Collaboration. New creatinine- and cystatin C-based equations to estimate GFR without race. N Engl J Med. 2021;385:1737-49. [PMID: 34554658] doi:10.1056/NEJMoa2102953 CrossrefMedlineGoogle Scholar5. Delgado C, Baweja M, Crews DC, et al. A unifying approach for GFR estimation: recommendations of the NKF-ASN task force on reassessing the inclusion of race in diagnosing kidney disease. Am J Kidney Dis. 2021. [PMID: 34563581] doi:10.1053/j.ajkd.2021.08.003 CrossrefMedlineGoogle Scholar6. Bundy JD, Mills KT, Anderson AH, et al; CRIC Study Investigators. Prediction of end-stage kidney disease using estimated glomerular filtration rate with and without race. A prospective cohort study. Ann Intern Med. 2022;175:305-13. doi:10.7326/M21-2928 Google Scholar7. Levey AS, Titan SM, Powe NR, et al. Kidney disease, race, and GFR estimation. Clin J Am Soc Nephrol. 2020;15:1203-12. [PMID: 32393465] doi:10.2215/CJN.12791019 CrossrefMedlineGoogle Scholar8. Velasco JD, Snodgrass B. The use of race in eGFR: why racial justice requires accuracy [Editorial]. Am J Med. 2021;134:827-8. [PMID: 33773970] doi:10.1016/j.amjmed.2021.02.013 CrossrefMedlineGoogle Scholar9. Casal MA, Ivy SP, Beumer JH, et al. Effect of removing race from glomerular filtration rate-estimating equations on anticancer drug dosing and eligibility: a retrospective analysis of National Cancer Institute phase 1 clinical trial participants. Lancet Oncol. 2021;22:1333-40. [PMID: 34399096] doi:10.1016/S1470-2045(21)00377-6 CrossrefMedlineGoogle Scholar10. Shi J, Lindo EG, Baird GS, et al. Calculating estimated glomerular filtration rate without the race correction factor: observations at a large academic medical system. Clin Chim Acta. 2021;520:16-22. [PMID: 34052206] doi:10.1016/j.cca.2021.05.022 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Kansas Medical Center, Kansas City, KansasDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-4875.Corresponding Author: Akinlolu Ojo, MD, PhD, MBA, University of Kansas Medical Center, 3901 Rainbow Boulevard, Murphy Hall Room, Mail Stop 1049, Kansas City, KS 66160; e-mail, [email protected]edu.This article was published at Annals.org on 11 January 2022. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPrediction of End-Stage Kidney Disease Using Estimated Glomerular Filtration Rate With and Without Race Joshua D. Bundy , Katherine T. Mills , Amanda H. Anderson , Wei Yang , Jing Chen , Jiang He , and Metrics March 2022Volume 175, Issue 3Page: 446-447KeywordsChronic kidney diseaseCreatinineEstimated glomerular filtration rateKidneysMedical dialysisRacial and ethnic issuesRenal failure ePublished: 11 January 2022 Issue Published: March 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...