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Kidney Week

Abstract: TH-OR65

Comparison of Estimated Glomerular Filtration Rate with and Without Race Adjustment on Associations with ESRD: The CRIC Study

Session Information

Category: CKD (Non-Dialysis)

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

Authors

  • Bundy, Joshua David, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Mills, Katherine T., Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Anderson, Amanda Hyre, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Yang, Wei, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Hamm, L. Lee, Tulane University School of Medicine, New Orleans, Louisiana, United States
  • Chen, Jing, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • He, Jiang, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
Background

Lower estimated glomerular filtration rate (eGFR) is strongly associated with higher risk of end-stage renal disease (ESRD). eGFR equations typically include adjustment for Black race, but this practice is controversial and the impact of its removal on associations with ESRD are unknown.

Methods

We included 3786 participants (mean age 57.8 years; 45.2% women; 41.8% Black) from the CRIC Study. ESRD was defined as initiation of dialysis or transplantation. We evaluated five CKD-EPI equations for calculating eGFR based on serum creatinine (SCr), cystatin C (CysC), and with or without race adjustment. We estimated associations and predictions of 5-year ESRD risk using Cox proportional hazards regression and the 4-variable Kidney Failure Risk Equation (KFRE), which includes age, sex, eGFR, and urinary albumin-to-creatinine ratio. Models were evaluated using measures of discrimination (AUC) and calibration (Brier score).

Results

Within 5 years after baseline, 642 participants developed ESRD and the cumulative incidence among Black and white/other participants was 22.5% and 15.4%, respectively. Across all eGFR equations, the KFRE was superior for prediction of 5-year risk of ESRD compared with eGFR alone among all participants (AUC range, 0.899-0.915 vs. 0.816-0.837 for eGFR alone; P<0.001). Among Black participants, the KFRE using creatinine-based eGFR without race adjustment improved calibration compared with the other equations (Figure).

Conclusion

The KFRE has superior discrimination for 5-year risk of ESRD compared with eGFR alone, regardless of whether race adjustment is employed. Removing the race adjustment for the creatinine-based CKD-EPI equation may improve prediction of 5-year risk of ESRD.

Funding

  • NIDDK Support