Abstract: PO2318
Elimination of the Race Coefficient from eGFR Calculation on Clinical Care and CKD Research Among a National US Veteran Cohort
Session Information
- Reassessing Race in Predicting Progression
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Gregg, L Parker, Baylor College of Medicine, Houston, Texas, United States
- Richardson, Peter, Baylor College of Medicine, Houston, Texas, United States
- Akeroyd, Julia, Baylor College of Medicine, Houston, Texas, United States
- Matheny, Michael Edwin, VA Tennessee Valley Healthcare System, Nashville, Tennessee, United States
- Virani, Salim S., Baylor College of Medicine, Houston, Texas, United States
- Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States
Background
Elimination of the race coefficient from the CKD-EPI equation has been proposed as an important step to improve healthcare disparities faced by Black persons with chronic kidney disease (CKD).
Methods
We identified U.S. Veterans with incident non-dialysis CKD stages 3-4 based on laboratory data from 2005-2019 from the Veterans Affairs (VA) Corporate Data Warehouse. Demographic characteristics and laboratory values were used to calculate estimated glomerular filtration rate (eGFR) by the CKD-EPI equation with and without the race coefficient. We identified Black persons who were reclassified from non-CKD to CKD status or to a different CKD stage, as well as individuals whose race was not reported and eGFR could not be calculated using a race-based equation. The number of additional persons with CKD identified without the race coefficient was evaluated by VA station.
Results
There were 1,765,410 individuals with CKD stages 3-4 by race-based eGFR. Eliminating the race coefficient resulted in reclassification of 119,142 (35.2%) Black individuals as having CKD stages 3a, 3b, or 4, accounting for a 6.7% increase in incident CKD among all races and a 54.3% increase among Black persons. Of reclassified Black individuals, 77% had hypertension, 14% had cardiovascular disease, 51% were prescribed either an ACE inhibitor or an ARB, and 48% were prescribed statins. There were also 245,340 individuals with unreported race who were newly classifiable as having CKD when eliminating the race coefficient. Median (IQR) number of reclassified individuals per VA station was 470 (110.5-1,393) reclassified Black persons and 1,550 (584-2,665.75) individuals of unidentified race (Figure).
Conclusion
Eliminating the eGFR race coefficient will lead to substantial but variable impact on clinical care and CKD research across VA locations nationally. Ideally this shift will achieve more equitable clinical outcomes for Black persons and expand inclusion in CKD clinical trials and observational research to advance CKD care.
Reclassified Black and unreported race patients with CKD per VA station
Funding
- Veterans Affairs Support