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Kidney Week

Abstract: PO2069

Transplant Clinician Opinions on Use of Race in the Estimation of Glomerular Filtration Rate: A National US Survey Study

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Lentine, Krista L., Saint Louis University School of Medicine, Saint Louis, Missouri, United States
  • Singh, Neeraj, LSU Health New Orleans, New Orleans, Louisiana, United States
  • Hippen, Benjamin E., Metrolina Nephrology, Charlotte, North Carolina, United States
  • Woodside, Kenneth J., University of Michigan Health System, Ann Arbor, Michigan, United States
  • Anand, Prince Mohan, Geisinger Health, Danville, Pennsylvania, United States
  • Cooper, Matthew, MedStar Health, Columbia, Maryland, United States
  • Dadhania, Darshana M., Weill Cornell Medicine, New York, New York, United States
  • Ainapurapu, Sruthi, Saint Louis University School of Medicine, Saint Louis, Missouri, United States
  • Doshi, Mona D., University of Michigan Health System, Ann Arbor, Michigan, United States
Background

Inclusion of race in eGFR calculation has raised controversies based on concern that assigning a higher GFR to Black patients delays opportunity for pre-emptive kidney transplant listing.

Methods

We conducted a survey of adult kidney transplant center staff in U.S (12/17/2020–2/28/2021) to assess opinions on use of race-based estimated GFR (eGFR) equations for waitlisting and living donor candidate evaluation, availability of serum cystatin-C testing and measured GFR, and related practices.

Results

Respondents represented 57% (124/218) of adult kidney transplant centers and 70.3% of recent practice volume. Nearly 95% of respondents felt that current race-based eGFR calculators need revision, primarily due to concerns around healthcare disparities and inaccuracies around reporting of race, particularly among multi-racial individuals. A majority of respondents (70.5%) believed that elimination of race would allow preemptive kidney transplant wait listing for Black patients, but a similar number (69%) also raised concern that removing race from GFR estimation could incur harms. One-third of responding programs lacked or were unsure of availability of cystatin C or mGFR at their institution. Nearly 15% of responding centers have removed race from GFR estimation and were either reporting eGFR for non-Black or ranges; 46% were planning to do so and 39.5% did not plan to change for now (Figure). There was no difference in GFR acceptance threshold for Black versus non-Black living donors.

Conclusion

This national survey highlights a broad consensus that extant approaches to eGFR calculations are unsatisfactory, but a range of opinion on what should replace the status quo. National consensus, guidelines, and infrastructure for laboratory testing are necessary to facilitate best practices to prevent further disparities in transplant care.