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Kidney Week

Abstract: PO0518

Impact of the Race Multiplier in the Estimated Glomerular Filtration Rate Equation on Care Delivery Among African-American CKD Patients

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Ahmed, Salman, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Mendu, Mallika L., Brigham and Women's Hospital, Boston, Massachusetts, United States
Background

African-American patients with chronic kidney disease (CKD) have poorer outcomes, including in dialysis access placement and transplantation. Estimated glomerular filtration rate (eGFR) equations, which assign higher eGFR values to African-American patients, may be an inadvertent mechanism for inequitable outcomes. Electronic health record-based registries enable population-based examination of care across racial groups.

Methods

Cross-sectional study at two large academic medical centers and affiliated community primary care and specialty practices.

Results

Of 2225 African-American patients, 743 (33.4%) would hypothetically be reclassified to a more severe CKD stage if the race multiplier were removed from the CKD-EPI equation. Similarly, 167 of 687 (24.3%) would be reclassified from stage 3B to stage 4. Finally, 64 of 2069 patients (3.1%) would be reassigned from eGFR > 20 ml/min/1.73m2 to eGFR < 20 ml/min/1.73m2, meeting the criterion for accumulating kidney transplant priority. Zero of 64 African-American patients with an eGFR <20 ml/min/1.73m2 after the race multiplier was removed were referred, evaluated or waitlisted for kidney transplant, compared to 19.2% of African-American patients with eGFR<20 ml/min/1.73m2 with default CKD-EPI equation.

Conclusion

Our study reveals a meaningful impact of race-adjusted eGFR on the care provided to the African-American CKD patient population.

Funding

  • Private Foundation Support