Glomerular Filtration Rate and Race

Glomerular Filtration Rate and Race Posted By:
...

In the United States, more than 37 million adults have either acute or chronic kidney disease. Unfortunately, kidney disease disproportionately affects a population group that is already facing health disparities and inequities: Most of these 37 million adults are Black, Hispanic or Latino, American Indian or Alaska Native, Asian American, and Native Hawaiian or Other Pacific Islander.

For years, the primary method for detecting and managing kidney disease has been estimated glomerular filtration rate (eGFR). To approximate kidney function, the traditional eGFR equation includes factors such as age, sex, race, body weight. Recently, however, it was noted that race is a social, rather than biological, construct and thus should not be used to determine eGFR. This was reaffirmed in a 2021 update sent to members of the American Society of Nephrology (ASN) and the National Kidney Foundation (NKF).

The update called for removal of race modifiers in equations used to estimate kidney function. It is also asserted that current race-based equations should be replaced to provide a standardized approach to diagnosing and managing kidney diseases; the replacement should be unbiased, accurate, and minimize inequalities. The ASN and NKF published their final report and recommendations in September 2021 and now recommend using the 2021 revised Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation to determine eGFR without a race variable. The equation applies to people with stable kidney function and estimates kidney function from serum creatinine, age, and sex. It is more accurate than the Modification of Diet in Renal Disease (MDRD) Study equation, particularly in people with higher levels of GFR. Additionally, confirmation of kidney function and GFR can be conducted by cystatin C plus serum creatinine testing.

The ASN and NKF have several follow-up plans to inform professionals and patients of the new recommendations and their impact on practice and treatment. Additional follow-up plans include provision of resources to aid in the removal of systemic racism in the nephrology setting in areas other than eGFR.

Although this is a just 1 small step toward solving healthcare inequalities, it is an excellent start for nephrology patients of different racial backgrounds. The NKF has stated that it will continue to work on closing healthcare gaps for communities of color and will advocate for increasing access to affordable healthcare. In addition, their CARES helpline is available to help all people with kidney disease; they also provide educational content for both patients and providers on the impact of kidney disease in diverse communities.

References
  • Delgado C, 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. AJKD. 2021;79:268.
  • Delgado C, et al. Reassessing the inclusion of race in diagnosing kidney diseases: An interim report from the NKF-ASN task force. JASN. 2021;32:1305.
  • National Kidney Foundation. Removing race from estimates of kidney function. www.kidney.org/news/removing-race-estimates-kidney-function. Accessed April 5, 2022.
  • Norris KC, et al. Removal of race from estimates of kidney function: First, do no harm. JAMA. 2021;325:135.

Share

Filed under: Curbside Consultations

Sign up to receive posts from The Exchange

Related
Pesticide Poisoning: What APPs Should Know

Pesticide Poisoning: What APPs Should Know

Pesticides—which can be found in insecticides, herbicides, fungicides, rodenticides, molluscic ...

Filed under: Curbside Consultations, Miscellaneous


Continue Reading
Hyperuricemia and Renal Disease

Hyperuricemia and Renal Disease

Gout and renal disease exist with a bidirectional relationship: gout can cause renal disease and ren ...

Filed under: Curbside Consultations, Rheumatology


Continue Reading
Yes, You Really Can Be "Allergic" to the Cold

Yes, You Really Can Be "Allergic" to the Cold

Cold-induced urticaria is a subtype of chronic inducible urticaria that affects approximately 0.05% ...

Filed under: Allergy/Immunology, Curbside Consultations


Continue Reading
Facilitating Behavior Changes

Facilitating Behavior Changes

I recently listened to a very good speaker on helping patients with behavior change. Dr Judson Brewe ...

Filed under: Curbside Consultations, Miscellaneous


Continue Reading
Vitamin D, Fish Oil, and Autoimmune Disease

Vitamin D, Fish Oil, and Autoimmune Disease

A recently published ancillary study found that patients 50 years of age and older who took daily vi ...

Filed under: Curbside Consultations, Public Health


Continue Reading
Arterial Occlusion, Part 1

Arterial Occlusion, Part 1

Today we are going to discuss arterial occlusion, as I have seen multiple lawsuits brought against a ...

Filed under: Cardiometabolic, Curbside Consultations


Continue Reading